Membership and Donation Form

Please print and then Fill in this form and receive the current Newsletter by return

Patient Education is an Important Part in the Management of the Condition

Complete and return this form to the secretary,

NASS Dingwall Branch, Touchwood cottage, Bayview, Edderton, Ross-shire, Scotland.

I wish to become a Member of NASS Dingwall Branch, and enclose Membership Subscription

Full membership gives you access to every physiotherapy class and all the other services.
Cost £12 per quarter employed £6 per quarter unemployed/OAP.

Affiliated membership gives you access to all the services, except physiotherapy classes.

Cost £5 per year, plus £1 for employed 50p unemployed/OAP for any physiotherapy classes your are able to attend.

I wish to make a donation to NASS Dingwall Branch: Donation £..............

TOTAL £ .................

Signature ....................................................................................................

Date ...................................

Surname .....................................................................................................

(BLOCK LETTERS: ADD MR/MRS/MISS OR OTHER TITLE)

Other names or initials .............................................................................

Address ..............................................................................................................................................................

Post code ..............................................

Telephone number: Home....................Work ................................

Occupation ................................................................................................

Do you suffer from Ankylosing Spondylitis?* ..........................................

*This question is asked so that we know what proportion of our membership are suffers