Signup or Renew Your Membership - Bristol Area Kidney Patients Association

Data Protection

As per our privacy policy, the personal information given below, will be sent to the BAKPA treasurer and membership secretary.

Full Member - Patient

Mr / Mrs / Miss / Ms

Name

Address

Address line 2

Post Code

Phone

Email Address

BAKPA would like to share your name and address with the National Kidney Federation (NKF), who will only use the information to send newsletters, raffle tickets etc. Yes, BAKPA can share my name and address with the NKFNo, please do not share my details with the NKF

News is updated regularly on our website and we also produce an occasional newsletter. Please indicate how you would like to receive BAKPA news

Send me news via emailSend me printed newsletters (one per household)I'll read it on the websiteYou can choose more than one

Additional Members aged 16 and over

Add full member (carer/spouse/partner)Add associate member(s)You can choose both options to add up to 2 other members

Full Member

Relationship to patient

Mr / Mrs / Miss / Ms

Name

Address

Address line 2

Post Code

Phone

Email Address

BAKPA would like to share your name and address with the National Kidney Federation (NKF), who will only use the information to send newsletters, raffle tickets etc.Yes, BAKPA can share my name and address with the NKFNo, please do not share my details with the NKF

News is updated regularly on our website and we also produce an occasional newsletter. Please indicate how you would like to receive BAKPA news

Send me news via emailSend me printed newsletters (one per household)I'll read it on the websiteYou can choose more than one

Associate Member

If applicable

Mr / Mrs / Miss / Ms

Name

Address

Address line 2

Post Code

Phone

Email Address

BAKPA would like to share your name and address with the National Kidney Federation (NKF), who will only use the information to send newsletters, raffle tickets etc.Yes, BAKPA can share my name and address with the NKFNo, please do not share my details with the NKF

News is updated regularly on our website and we also produce an occasional newsletter. Please indicate how you would like to receive BAKPA news

Send me news via emailSend me printed newsletters (one per household)I'll read it on the websiteYou can choose more than one

Add another Associate Member

Add member

2nd Associate Member

If applicable

Mr / Mrs / Miss / Ms

Name

Address

Address line 2

Post Code

Phone

Email Address

BAKPA would like to share your name and address with the National Kidney Federation (NKF), who will only use the information to send newsletters, raffle tickets etc.Yes, BAKPA can share my name and address with the NKFNo, please do not share my details with the NKF

News is updated regularly on our website and we also produce an occasional newsletter. Please indicate how you would like to receive BAKPA news

Send me news via emailSend me printed newsletters (one per household)I'll read it on the websiteYou can choose more than one

Add another Associate Member

Add member

3rd Associate Member

If applicable

Mr / Mrs / Miss / Ms

Name

Address

Address line 2

Post Code

Phone

Email Address

BAKPA would like to share your name and address with the National Kidney Federation (NKF), who will only use the information to send newsletters, raffle tickets etc.Yes, BAKPA can share my name and address with the NKFNo, please do not share my details with the NKF

News is updated regularly on our website and we also produce an occasional newsletter. Please indicate how you would like to receive BAKPA news

Send me news via emailSend me printed newsletters (one per household)I'll read it on the websiteYou can choose more than one

Your privacy *I/We acknowledge that information offered on this form is sent to the BAKPA treasurer & membership secretary and that if newsletters were subscribed to, I/We can unsubscribe at any time following the instructions provided in them. As explained above (if you did not choose to opt out) BAKPA may also share the information with the National Kidney Federation (NKF).

Gift Aid Declaration - Please read the Gift Aid description at top of page

All donations I make to Bristol Area Kidney Patients Association from the date of this declaration are to be Gift Aid until I notify you otherwise.

Enter membership(s) total (£2 per person)

GBP

If you would like to make a donation, enter amount (£), otherwise leave blank

GBP

Total (£)