Application form

To join the HSP Support Group please either fill in this online form or download our membership application form and return it to our Membership Secretary. Healthcare professionals can join the HSP Support Group for free - please fill in our Honorary / Associate membership form.

Please note that applications can only be accepted from people who are resident in Great Britain & Northern Ireland. For organisations in other countries please visit our global support group links.

Data protection - The HSP Support Group has a data protection policy that defines what data we hold and how it is used. View our policy page to find out more.

Title *

Name *

First

Last

Address *

Postcode *

Date of birth (dd/mm/yy) *

Email *

May we send your newsletter to this email address? *

Sending a digital version of the news letter saves us considerable money.

Telephone / mobile *

Relationship with HSP *

I have HSP or similar symptoms
I am a Carer for someone with HSP or similar symptoms
Someone I know has HSP or similar symptoms
I have some other interest in HSP

Gift Aid (this section is optional). If you are a UK taxpayer then donations and your membership subscription can be increased through the Gift Aid scheme. Every £1 you donate becomes £1.25 at no cost to yourself.

Yes I would like tax to be reclaimed on any eligible donations or membership subscriptions that I have ever made or will make to the HSP Support Group until further notice. I confirm that I pay an amount of UK income or capital gains tax at least equal to the tax that the HSP Group will reclaim.

Signature for Gift Aid scheme (please print full name)

Date of Gift Aid signature (dd/mm/yy)

Payment *

I have set up a standing order to pay £15 immediately and then annually on May 1st
I have made a bank transfer to pay this year’s membership only

All payments can be made either via online banking or by visiting your local branch.
For those paying via standing order, please make the first payment, then set up the standing order for 1st May annually. If you would prefer to send a Standing Order mandate to your bank via the post, please download our membership form, fill in section 3 and send to your bank.

Membership is £15. If you are a pensioner or have limited means then the fee is reduced to £10.

HSP Support Group
Barclays Bank
Sort code: 20-78-42
Account number: 1083 8160

Signature (please print full name) *

Joining date (dd/mm/yy) *

Name

Application form

Meeting (near Leeds/York)

Monthly Zoom meeting for all members

Monthly Zoom meeting for all members

Monthly Zoom meeting for all members

Monthly Zoom meeting for all members

Monthly Zoom meeting for all members

Monthly Zoom meeting for all members

Monthly Zoom meeting for all members

Monthly Zoom meeting for all members

Monthly Zoom meeting for all members

Monthly Zoom meeting for all members

Monthly Zoom meeting for all members