LHM Membership Form – Health, Education & Social Services Professional

Your Details

Your Name(Required)

First Last

What is your profession?(Required)

Where do you work?(Required)

Email(Required)

Hospital/Work Address(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code

Phone Number(Required)

Your ethnicity(Required)

What is your involvement with children and young people with a single ventricle heart condition?(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 our full Membership Terms and Conditions here: LHM Membership Terms & Conditions

We may also contact you by email or SMS about fundraising campaigns, events, appeals, and other ways to support Little Hearts Matter. If you would prefer not to receive fundraising communications by email or SMS, please tick below:

No Fundraising emails

No Fundraising SMS

You can update your communication preferences or opt out at any time by contacting info@lhm.org.uk

LHM Membership Form – Health, Education & Social Services Professional

Your Details

Contact Consent

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

Main office