WDSSG Membership Form

    Your Name (required)

    Your Address (required)

    Your Email address (required)

    Your Contact telephone numbers

    Telephone:
    Mobile :

    Please tick as appropriate.

    , 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.

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