Membership Application Form

Section 1: Contact details

Contact details of the person paying the membership fee. All fields marked with a * are required.

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Sex *

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Do you have scoliosis? *

Are you a relative/carer of someone with scoliosis? *

Please complete Section 1a if you have answered ‘Yes’ to the question above.

If your answer was 'No' please move on to Section 2

If you answered ‘No’ to both questions above please go to Section 3.

Section 1a: Contact details

Contact details of person with scoliosis

Sex

Address (if different from above)

Section 2: Scoliosis history

Type of scoliosis

When was the scoliosis first diagnosed?

What treatment has been received to date:
(tick relevant boxes and provide additional information if necessary)

If applicable please give details of the scoliosis surgery:

Section 3: Membership options

Based on the information given on this form SAUK will provide you with contact details of people who are going through/have been through a similar experience.

SAUK has three types of membership depending on whether you would like your contact details available for other members who join. Please read each description and choose the membership option that best suits you.

Full membership

Is for those members who are happy for their contact details to be given to new members who sign up who either live in their area or have gone through a similar experience.

Reserve membership

Is for those members who do not want their contact details sent to new members who join.

Associate membership

Is for organisations or persons working in the area of scoliosis.

Membership Type *

Gift Aid

With your permission the Scoliosis Association (UK) is able to claim tax back on your membership fee. This means that for every pound you give, SAUK receives an extra 28 pence from the Inland Revenue, helping your contribution go further at NO additional cost to you.

Please note: You must be a UK taxpayer and expect to pay at least as much income tax and/or capital gains tax this year as the SCF will reclaim on your donation. If future circumstances change and you no longer pay tax on your income and/or capital gains equal to the tax the SCF reclaims, you can cancel the declaration. If you pay tax at a higher rate, you can claim further tax relief in your self-assessment tax return. Please contact your local tax office for leaflet IR113 'Gift Aid' for further information.

Please choose one of the options.

Gift Aid Options *

Share options:

Please note: Your details will only be used for SAUK’s purposes and will under no circumstances be passed on to third parties.

Prefered Payment Method *