WDSSG Membership Form

Your Name (required)

Your Address (required)

Your Email address (required)

Your Contact telephone numbers

Telephone:
Mobile :

Please tick as appropriate.

I have WDS/CBPS

I/we are the parents/guardian of a child affected with WDS/CBPS

I/we am an interested relative/friend of a person with WDS/CBPS

I am a professional who works with people who have WDS/CBPS

Other, please state below

I/we DO NOT wish to be contacted by other families.

I/we DO NOT wish my details to be passed on to medical professionals.

Please note that the data protection act forbids the free distribution of members’ details without their express permission.

Please prove you are human by selecting the car.