Membership Form
Cleft Friends a project of the Smile Foundation is a support group in South Africa for parents and adults affected by cleft lip and palate.

Title *
First Name *
Your answer
Last Name *
Your answer
Contact Details
Email *
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Phone *
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Address
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Suburb
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City/Town *
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Province *
I would like to receive
Cleft Friends email newsletters
Information about fundraising for Cleft Friends
Information about receiving parent support for my child who has a cleft lip and/or palate
Information about becoming a Cleft Friends support parent
Please DO NOT contact me for any of the above reasons
About You
Please select the option(s) below that best describe your connection to Cleft Friends
I was born with a cleft lip and/or palate
I am a parent/guardian of a child with a cleft lip and/or palate
I have some other personal connection to cleft
e.g. grandparent, sibling, friend of someone with a cleft lip and palate
I am a health professional
Ethnicity
Preferred Language
Please fill in if your preferred language is NOT ENGLISH
Your answer
Data Protection Statement
Cleft Friends a project of the Smile Foundation is committed to data protection and will never pass on your details to any third party without your consent.

We may use data in the following ways:
- to provide us with statistics about the cleft community in South Africa
- to advertise relevant events and opportunities to you directly

You can unsubscribe from our email newsletters at any time using the "Unsubscribe"at the bottom of every email. You can also email info@cleftfriends.co.za at any time to request that your information be changed or deleted.

By submitting your data to us using this form, you are certifying that the details you have entered are correct to the best of your knowledge and that you have permission to share them with us. You also agree to Cleft Friends a project of the Smile Foundation using your data in the above ways. If you have any questions or concerns about this, please email info@cleftfriends.co.za.

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