LHM Membership Form – Extended family member

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LHM Membership Form – Extended family member

Your Details

Your Name(Required)
Address(Required)

Child's Details

Heart Child's Name(Required)
Child's Date of Birth(Required)
Please give as much detail as possible here. If you are unsure about the diagnosis, what has your doctor / consultant said about future treatment?
Are the parents of the child also members of LHM?
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 or calling us on 0121 455 8982.
Membership Terms(Required)
LHM Membership Terms & Conditions

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