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Membership Form

Membership is open to parents or guardians of children with hand or arm deficiencies, and to professionals, relatives or other individuals who may be interested in supporting Reach in its work.

The Full UK Membership fee is £25.00 per year.
The Full Overseas Membership fee is £35.00 per year.
The Overseas Electronic Membership fee is £25.00 per year.

Members receive the quarterly newsletter "Within Reach" and access to all publications and information held by the Association.
Members may join their local branch.

Member's children are automatically registered as junior members and no seperate subscription is required.

Under the present constitution one membership allows for one vote. If both partners feel they may wish to vote on constitutional matters then they should consider two subscriptions.
Information about you (Please include both parents if joining on behalf of a child)
*Name 1: Title:
First name: Surname:
Name 2: Title:
First Name: Surname:
*Address:
* City:
*Post Code:
*Country:
 
Telephone No:
Mobile Phone:
*Email:
*Password: (for access to Member's Area)
*Confirm Password:
Professional Details: (if applicable)
Where did you find out about Reach?
Information about the child (if applicable)
Full Name:
Date of Birth(dd/mm/yyyy):
Which hand/arm is affected?

Please describe what the limb looks like and its function
Name of centre dealing with your child:
Please answer the following by indicating Yes or No as appropriate.
 Is there any other birth defect?
 If yes has it been named?
 Has surgery been offered?
 Has surgery been undertaken?
 Is surgery planned?
Have artificial limbs/devices been offered/supplied?
 Would you be willing to be contacted by other members of 'Reach' whose children have similar problems to yours?
Please give more details about other birth defects, artificial limbs or surgery if you answered Yes to any questions above:
Other Children
If you have other children please enter their details:
Child 1: Name: Age:
Child 2: Name: Age:
Child 3: Name: Age:
Child 4: Name: Age:
Payment:
Membership Type:
Payment :
Donation:
*Total
I am a UK tax payer and would like Reach to reclaim tax on this and any future donations under the Gift Aid scheme.