Crohn's and Colitis UK - Membership Application

To join NACC and pay by cheque or by postal order please enter your details, click "Print Application Form" at the end of the page, sign the printed form and post it with your payment to: NACC, 4 Beaumont House, Sutton Road, St Albans, Herts AL1 5HH. Payment can be accepted by Cheque or Postal Order. Alternatively, click here if you would like to pay by Credit or Debit Card

You must be at least 16 years of age to become a NACC member in your own right. Parents are welcome to join on behalf of a child and can authorise us to print the "Can't Wait" Card in their child's name. To do this, simply enter details in the Membership-and-Can't-Wait-card-details section of this application

Title:

(Dr, Ms, Mr, Mrs, Miss, etc)

Forename:

Surname:

Address:

Postcode:

Telephone: Home:

Work:

E-mail:

Date of birth:

Occupation (is/was):

How did you hear about NACC?

You are:

Illness:

Year of diagnosis:

Have you previously ever been a NACC member?

Membership and "Can't Wait" card details

I am joining for a relative or friend. If so please give their details below:

Their full name:

Relationship to you:

Their date of birth:

Can we inform your local NACC group of your membership, so that they can let you know about local activities?
If you are joining as a parent please confirm that NACC may pass the above information about you/your child to the relevant NACC Groups

Membership Subscription. NACC members are asked to pay an annual subscription of £12. New members who are on a low income due to their health or employment circumstances may join at a reduced rate. Please email on the NACC membership team for more information. Overseas members are asked to pay £15 annually. Additional donations to help the work of the Association are always welcomed.

Subscription:

Donation:

Direct debit Would you like us to send you a Direct Debit form for your subscription renewals?
Gift Aid. Do you pay income or capital gains tax in the UK?
Answering yes to this final question will print a Gift Aid Declaration form with your membership application form. Completing this form and sending it to NACC will allow us to reclaim your tax on your subscription. This can add nearly one third to the value of your subscription at no cost to you.

NACC needs the data requested above to enrol you as a member of the Association and to be able to send you information relevant to your membership. A statement of NACC's Data Protection Policy can be obtained from the Director.

I authorise NACC to hold the personal data I have provided and use it to send me further information about NACC and my membership. Or, if you are joining as a parent, I confirm that NACC may hold the above information about me/my child.