LHM Membership Form – Adult with a single ventricle heart

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LHM Membership Form – Adult with a single ventricle heart

Your Details

Your Name(Required)
Your Date of Birth(Required)
Address(Required)
Some people use a different name on social media. Providing this will help us speed up your acceptance into our private groups.
Gender(Required)
Please give as much detail as possible here. If you are unsure about the diagnosis, what has your doctor / consultant said?
Max. file size: 10 MB.
Are any relatives/family also members of LHM?(Required)
Where did you hear about us(Required)

Contact Consent

By completing this form, you understand that we may contact you about your membership, support services, fundraising activities you are involved in, and other information necessary to administer your relationship with Little Hearts Matter. Please see full Fundraising Terms and Conditions here: LHM Fundraising Terms & Conditions

Emails:(Required)
SMS(Required)
You can update your communication preferences or opt out at any time by contacting info@lhm.org.uk

Contact Preferences

Would you like to be put in touch with someone who has shared similar experiences?(Required)
Membership Terms(Required)
LHM Membership Terms & Conditions

If you have a partner or an extended family member who would like to be a member of LHM

MEMBERSHIP OF THE CHARITY REQUIRES AN OPEN AND HONEST SUBMISSION OF INFORMATION ON APPLICATION AND DURING THE TERM OF THE MEMBERSHIP