Ménière's Society

This is the text-only version of the Web site. Click the 'bigger text' and 'smaller text' links below for the standard site.

Skip to content

How to join

To join, please print out this form and send it with your payment to the following address:

The Ménière's Society
The Rookery
Surrey Hills Business Park
Wotton
Dorking
Surrey
RH5 6QT
United Kingdom

Please complete in block capitals:

Mr/Mrs/Miss/Ms:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Surname:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

First name(s):

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Address:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Post code:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

County/country:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Telephone number:   

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Age:

Tick box Under 20     Tick box 20-34     Tick box 35-49     

Tick box 50-64     Tick box 65-79     Tick box 80 and over

How did you hear about us?   

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Annual membership rates

Please tick the appropriate box. Please note we do not have credit or debit card facilities.

Tick box Individual £16

Tick box Organisations from £24

Tick box Overseas* £24

*Includes Irish Republic. All payments from overseas by bank draft in Sterling, please.

I enclose an additional donation to assist the Society's work:
£ _ _ _ _ _ _ _ _ _ _ _

Please make all cheques payable to the Ménière's Society.

For information on Gift Aid, click here.