ME North East Young People’s Group
Printable Membership Form

Name……………………………………………………………………………….

Address…………………………………………………………………………….

………………………………………………………………………………………

……………………………. Post Code……………………………………………

Tel No………………………………. E-mail …………………………………….

Date of Birth…………………………………………….. Age……………………

Approx length of illness…………………………………………………………..

Tell us about your hobbies and interests………………………………………..

……………………………………………………………………………………..

……………………………………………………………………………………..

Where did you hear about ME North East……………………………………..

Signature (parent/carer to sign if under 16)…………………………………….

If as a parent/carer, you wish to be on our mailing list copies of the Focus Newsletter for adults please print and sign below.

Print…………………………………Signature…………………………………..


Please return to ME North East, Bullion Hall, South Approach,
Chester le Street, Co Durham. DH2 2DW.