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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…………………………………..
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