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Supporting people affected by Charcot-Marie-Tooth disease.

Sign up to become a Member of CMT UK

When completing this form, you are giving your consent for Charcot-Marie-Tooth UK to store this information on our database, for the purposes of administering our membership scheme.   If you would like any further information about our privacy policy, please click here, or phone 01202 474203.

We are committed to keeping your personal information private and NEVER share your data with any outside parties.

Title
First Name
Last Name
Email
Address line 1
Address line 2
Address line 3
City/Town
County
Are you outside the UK
Postcode
Country
Telephone
Mobile
Date of birth
I would like to receive the magazine by;
   
Type of CMT
Diagnosing Consultant
Specialism
Hospital
Year of diagnosis

 

If you have children, with or without CMT, it helps us to tailor our services. Please be assured that this information is NEVER shared outside of CMT UK.

First name Last name DOB CMT
1
2
3
4

 

   
What is your ethnic group?
   
   
I want Charcot-Marie-Tooth UK to treat my donations and subscriptions as Gift Aid donations.
I confirm that I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6th April to 5th April) that is at least equal to the amount of tax that all charities that I donate to will reclaim on my gifts for that tax year. I understand that other taxes such as VAT and Council Tax do not qualify. I understand the charity will reclaim 25p of tax on every £1 that I have given
Gift Aid Declaration
   
Would you like to becaome a member of the Facebook group for CMT UK. This is our replacement to the forum and is a closed group for paying members only.
Facebook Group
Please give your consent for the following use of your information in order that we comply with current and future Data Protection rules;

To send you Grand Prize Draw tickets

To send you very occasional fundraising information, other than Grand Prize Draw tickets

To add your email address to MailChimp so that you might receive our monthly E-ComMenT bulletins (from which you can separately unsubscribe at any time).

To send you occasional surveys by post or email.

To pass your basic contact information onto our authorised local group organisers, so that you might be included in their mailings regarding local meetings.

To be contacted by Paula Hunter, our PR consultant, to share your story for Awareness Raising purposes. If you are happy for this, Paula will contact you by phone or email, ONLY if she is looking for volunteers in your particular area, and she will talk you through the whole process. You can back out at any time.

 

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