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Postal Renewal Form

I wish to renew my Gold membership of the Hughes Syndrome Foundation
Name
 …………………………………………
Address
 …………………………………………
 
 …………………………………………
 
 …………………………………………
Postcode
 …………………………………………
Telephone number
 …………………………………………
Email
 …………………………………………
 
  
I enclose my cheque for
 …………………………………………
   

Annual rates - UK Membership £33, Non-UK Membership £38
(if sending a foreign currency cheque, please convert using the current exchange rate)
   
   
Payable to:
 The Hughes Syndrome Foundation
 
  
Signature
 …………………………………………
Date
 …………………………………………
   

Please send your form and cheque to:

The Hughes Syndrome Foundation
Conybeare House
Guy's Hospital
London
SE1 9RT		 Many thanks!