UK NATIONAL KIDNEY FEDERATION
Friends Membership Application Form

Please complete the following details on-screen, then print and send by snail mail to the National Kidney Federation, The Point, Coach Road, Shireoaks, Worksop, Notts S81 8BW with your subscription/direct debit (see Guidance Notes on NKF Membership page).

Title:
First Name:
Last Name:
Address:



Postcode:		Telephone:
EMAIL address:

Membership Subscription (Minimum £20, please click appropriate button)

£20 £30 £40 £50 Other £

Payment Type (please click appropriate button)

Direct Debit Gift Aid by Cheque/Postal Order

Cheque/Postal Order

If you are a patient or carer, do you know the name of your local Kidney Patient Association? If so, please type in their name (eg Bristol Area KPA):

I wish to become a Friend of the National Kidney Federation.

Signature:

Date:

The National Kidney Federation is registered in England and Wales as a Company limited by guarantee (Company No 5272349) and awarded charitable status (Charity Number 1106735). Give as You Earn contributions No. CAF GY511. Registered Office:- The Point Coach Road Shireoaks Worksop Notts S81 8BW	Tel: Fax: Helpline: E-mail:	(01909) 544999 (01909) 481723 (0845) 601 02 09

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Last updated: 14 May 2008

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UK NATIONAL KIDNEY FEDERATION Friends Membership Application Form

UK NATIONAL KIDNEY FEDERATION
Friends Membership Application Form