Membership Postal Gold Form

Postal Membership Form I wish to become a Gold member of the Hughes Syndrome Foundation
Name	ЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕ
Address	ЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕ
	ЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕ
	ЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕ
Postcode	ЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕ
Telephone number	ЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕ
Email	ЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕ

I enclose my cheque for	ЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕ

Annual rates - UK Membership г33, Non-UK Membership г38 (if sending a foreign currency cheque, please convert using the current exchange rate)


Payable to:	The Hughes Syndrome Foundation

Signature	ЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕ
Date	ЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕ

Please send your form and cheque to:
The Hughes Syndrome Foundation Louise Coote Lupus Unit Gassiot House St ThomasТ Hospital London SE1 7EH	Many thanks!