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Affiliate Membership form

  1. Please select the following annual membership rate that applies to your organisation(*)

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  1. First name(*)
    Please enter your firstname
  2. Last name(*)
    Please enter your last name
  3. Email(*)
    Please enter a valid email address.
  4. Re-enter email(*)
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  5. Organisation(*)
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  6. Job title
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  7. Address line 1(*)
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  8. Address line 2
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  9. Address line 3
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  10. Town(*)
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  11. County
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  12. Post Code(*)
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  13. Telephone(*)
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  14. How many carers do you reach with your support and services?(*)
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    Please give an estimate of the number of carers you provide information, support or services to each year.
  15. Alternate invoice details

    We will send you a copy of the invoice to the details provided above. If you'd like to pay by direct debit, please email to request a form.

    If you need to send the invoice to someone other than yourself please add their details here:

  16. Name
  17. Email
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  18. Address
  19. How did you hear about us?
    Please tell us where you heard about us.
  20. If other please specify:
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  21. Please type the letters / numbers you see.(*)
    Please type the letters / numbers you see.   RefreshPlease add the characters you see in the box provided to prove you are a human.
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Your donations are an essential part of helping us make life better for carers.

How you can help

Carer and son

With your help we can reach more carers with timely support and advice.



We will keep campaigning until every carer gets proper recognition and support.

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