Application for membership of Oxford Branch of Parkinson's UK

If you would like to become a member, please provide your details on this page. You can apply:

• for yourself alone (membership £5 per year),
• or for yourself and a partner, carer or supporter (£10 per year for two people).

When you have completed the form, you can submit your application using the instructions at the bottom of the page.

Thank you for your interest in joining our Branch, and we look forward to seeing you at our monthly meetings and our many other events.

Tell us about yourself

Please fill in your details

Title (optional) My first name My family name I am a... Person with Parkinson's (PwP) Unpaid carer Paid carer or care worker Other, not applicable, or prefer not to say My email address

Home address Address line 1 Address line 2 (optional) Address line 3 (optional) Town or city Postcode

Preferred phone number

Optional information

Alternative phone number Parkinson’s UK national membership number

How many people on this application?

This application is for only one person

Add a second person (for example, a partner or carer) to this application

If you would like to include more than two people on your membership, please apply for two at first and then speak with our Membership Secretary to discuss adding further people.

Tell us about the second person

Title (optional) First name Family name Their relationship to me: My spouse or partner A relative Other, or prefer not to say They are... Person with Parkinson's (PwP) Unpaid carer Paid carer or care worker Other, not applicable, or prefer not to say

Optional contact information for second person

Leave any information blank if it is the same as for the first person.

Their email

Their home address Address line 1 Address line 2 (optional) Address line 3 (optional) Town or city Postcode

Preferred phone number Alternative phone number

Additional information (optional)

Is there anything else that you would like to tell us about? For example, you could mention any topics for meetings or events that would particularly interest you, tell us how you found out about the Branch, or say how you would like to contribute to our activities.

Nearly done!

You provided this email address:

 

Please check very carefully that it is correct. We cannot get in touch with you if it's wrong or missing! To fix any mistakes, please click here to go back and correct it.

By clicking this "submit" button, you agree that we can use your contact details to send you information about Branch membership, activities and events.

We can only accept your online application if you allow us to use your email address and other contact information in this way. If you do not agree to this, do not submit this form. Instead, please go to our contact page to find alternative ways to get in touch with our Membership Secretary and ask about membership.

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Parkinson's UK is the operating name of the Parkinson's Disease Society of the United Kingdom.

A registered charity in England and Wales (258197) and in Scotland (SC037554). Registered office: 215 Vauxhall Bridge Road, London SW1V 1EJ.