Membership Postal Form

Postal Membership Form I wish to become a standard 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 г20, Non-UK Membership г25 (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 Conybeare House Guy's Hospital London SE1 9RT	Many thanks!