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Joining the British Polio Fellowship
If you would like to join the British Polio Fellowship and keep abreast of news and information about polio and polio-related issues, please print out this form.
1: Type of membership
Which branch would you like to join? ...................................................................................
I would prefer instead to be a Central member.
Yes No
(please circle)
2: Membership Fees

To reduce administrative costs we have introduced a one-off life membership charge
(please enquire if you have difficulty paying this charge in one go - we can be flexible).
Currently the life membership fee is £25.
3. Personal details
Title:.............. Date of Birth:................
Surname:........................................................................................................................
Forenames:.....................................................................................................................

Address:.........................................................................................................................
.....................................................................................................................................
...............................................................Post code:.............................

Phone number:..................................................
Have you had Polio.
Yes No
(please circle)
Year polio contracted (If applicable):

Where did you hear about the fellowship?

 19.........

................................................................................

Please send your completed application form and payment to:

 

(cut out & stick our address to your envelope if required)

The British Polio Fellowship
Eagle Office Centre
The Runway
South Ruislip
Middlesex
HA4 6SE

Thank you