N.A.S.S LONDON

Membership and Donation Form


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

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

Complete and return this form to the Director,

National Ankylosing Spondylitis Society, 5 Grosvenor Crescent, London SW1X 7ER.

I wish to become a Member of NASS, and enclose Membership Subscription 10.00 N.B.

Un waged U.K 3.00 Overseas 12.00

I wish to make a donation to NASS Donation ..............

The Annual Subscription Includes the twice yearly Newsletter

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