Join Online

Membership is free. Please tell us as much or as little as you wish in order to register with us. Please complete the following to register with us. Remember to call us with any problems, concerns or issues you want to chat through with somebody.

* = Required

1. Your Details.

Title

First Name*

Last Name*

Gender*

Male
Female

Date Of Birth
*Required if you are personally affected by 22q deletion or 22q duplication.

2. Your Contact Details

Email Address*

Telephone

Mobile Phone

Street Address*

Town/City*

County/Region*

Postcode*

Country

3. Please tick AT LEAST ONE of the following statements which apply to you.

I am personally affected by 22q deletion

I am personally affected by 22q duplication

I am a relative or carer of a person/s with 22q.

I am a Medical Professional/Education/Other Service Provider.

I want to volunteer to help Max Appeal.

I am interested in Fundraising for Max Appeal.

Go to our main website: www.maxappeal.org.uk

Registered Office: 15 Meriden Avenue, Stourbridge, West Midlands, DY8 4QN