BIRMINGHAM AND DISTRICT TINNITUS GROUP
Registered Charity Number 1053184
 

 

Membership Application/ Donation/ Order Form
*(denotes required field)
 

I would like to pay by*: ChequePaypal (opens new page for submission)

If paying by cheque, please fill out and print this form to post

 
First Name*/Surname*:
Address Line 1*:
Address Line 2:
Address Line 3:
Town / City*:
County*:
Postcode*:
   
Telephone Day*/ Eve:
     
E-mail*:
I wish/don't wish to become a member of the Birmingham Group and enclose;
 
 
 Plus Donations to research etc.
 TOTAL
 
 
 

If Paying by Cheque, please make payable to 'Birmingham Tinnitus Group' and after filling in the form, please use the print function below and post form to:

 
 
The Membership Secretary
Membership B&DTG
BID Services
The Deaf Cultural Centre
Ladywood Road
Birmingham
B16 8SZ
 
 

Important  Do you pay tax and are you a resident of the U.K? If you can answer yes to both of these questions please tick the box below. This will allow us to claim back further money from the Tax Office without any costs to yourself. Thank You.   Tick here

 

Copyright 2006- Birmingham and District Tinnitus Group