Join Us

Network MESH (West London) Membership Form

We rely primarily on donations, mainly to finance the cost of the newsletter, which we aim to publish 4 times a year, the website and social events on Zoom. There is no charge for membership. If you want to become a member, please fill in this form and press "Submit" or just press "Print" to print out this form to fill out by hand and post to Martin at the address below. If submitting the completed form online, and should you wish to make a donation (and there is no pressure to do so), cheques should be sent separately to Martin; please include the name you have registered with on the back of the cheque. The "Submit" and "Print" buttons are at the end of the form.

If your illness makes this too difficult for you, contact membership@networkmeshwl.org.uk and we will put a form in the post to you.

We would, of course, be grateful for any donation you can give. We are sorry but it is not possible to donate online.

Please fill in your details and tick the appropriate boxes below.

* indicates required field

Select a contact:*

First Name:*

Last Name:*

Email:*

Re-Enter Email Address*

Address*

Post Code*

Telephone Number

I would like to:*

Renew my membership of Network MESH
Become a member of Network MESH

How would you like to receive our quarterly newsletter?*

As a paper newsletter by post
As an electronic file (PDF) by email

Indicate here if you want your details circulated to other members*

Yes
No

If you would like to make a Donation

Please enter the amount that you wish to donate:

I will send my donation payment to the membership secretary

Please make cheques payable to “Network MESH”, write the name you are registering on the back of the cheque and send (with this form if not submitted below) to:

Martin Sondergaard, 145 Leighton Road, Ealing, W13 9DR.
Tel: 020 8840 9445 After 2.00 pm ONLY.
Email: membership@networkmeshwl.org.uk

Data will be stored and collated within the guidelines of the Data Protection Act and not passed on to third parties (See Network MESH website-email-database code for more details)

Gift Aid Declaration

If making a Donation, please fill in the form below, if you have not done so before, ONLY IF you are a UK taxpayer.

It helps us because we claim 25p from the Inland Revenue for every £1 donated. The amount you pay in tax must at least equal the amount we claim in the tax year.

*****************************************************

Network MESH (West London). Registered Charity No. 1099950

First Name

Surname

Gift_Aid_Address

Gift_Aid Post Code

Date

I want all donations I’ve made since 6 April 2000 and all donations in the future to be treated as Gift Aid until I notify you otherwise.

Confirm Gift Aid*

Yes
No

______________________________________

How did you find out about Network MESH?

______________________________________

A few short Questions about you:

We find it helpful if members tell us a little bit about themselves and their ME. So please fill in the few short questions if you can.

How old are you? (please leave blank if you prefer not to say)

How long have you been ill?

Are you mildly, moderately or severely affected?

Do you need help on a daily basis from a partner, carer etc?

Is your GP helpful or unhelpful?

Name any therapies you feel have made you better?

Any therapies that have not helped?

Any that made you worse?

How would you describe yourself and your ME?

Is there anything else you want to add about your health?

Any Other Information

You can print this page with the form blank or completed, prior to clicking "Submit"

Remember to click "Submit" if you want to send the completed form to us automatically

One thought on “Join Us”

Heidi January 7, 2014 at 12:51 pm

Hello Joanna, welcome to the group! The group is run entirely by people with ME so we all know very well what the impact of this illness can have on a person’s life. I hope you are well enough to come to some of our social meetings, but even if you are not, you will be receiving our newsletter to help you feel a part of our little community.

Heidi

Reply ↓

Network MESH West London

The West London ME/CFS Self-Help Group

One thought on “Join Us”

Leave a Reply Cancel reply