PIP-UK Community Membership Form
By joining PIP-UK you are supporting our 4 main aims:

šŸ’š Foster partnerships with Medical Professionals
šŸ’š Support
šŸ’š Signpost
šŸ’š Raise awareness in professional networks

Also:
You will be invited to our events, including Weekends Away, Online talks etc.
Provide your input about how we can best support our aims.
Receive information about the Poland Syndrome Community Register.
Supporting the valuable work we offer to everyone affected by Poland Syndrome.
PIP-UK will provide advice and support through telephone helpline, email and social media.

NEW MEMBERSHIP REGISTRATION FORM

Membership is open to people with Poland Syndrome, Parents, family members or guardians of children with Poland Syndrome, and to professionals, relatives or other individuals who may be interested in supporting PIP-UK in its work.

PIP-UK operates across the UK and Ireland. For people in other countries world-wide we offer a membership that gives you access to our support and advice. We can offer some assistance and advice to overseas members, but each country's healthcare provision is different, so we are unable to provide definitive advice. Member's children are automatically registered as junior members and no separate subscription is required.
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Email *
First Name *
Surname *
Tel Number (Mobile) *
Address *
Postcode/Zip Code/Area Code *
Are you signing up for yourself or your child? (Please tick) *
Required
Information collected is used so that we can contact you, give you the right kind of support, and for our long-term goal of creating a patient register to help raise awareness of Poland Syndrome.
Do you agree for your personal information to be held by PIP-UK and stored using a confidential database? *
Required
I have read and understood this agreement and I happy to be contacted by PIP-UK for purposes listed above. *
Required
A copy of your responses will be emailed to the address you provided.
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