Yes I would like to join the Alzheimer's Society
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(PLEASE USE BLOCK CAPITALS)

Name________________________________________________________________

Address_____________________________________________________________

       _____________________________________________________________

       _____________________________________________________________

       ________________________________Post code____________________

Phone number________________________________________________________


I wish to join the Alzheimer's Society and receive the
monthly newsletter.
I enclose my payment for:

£8__    £12__     £25__    £50___   Other___

There is no fixed subscription. Please give generously. (Thank you.)
However, if you are a carer and would like free membership,
please tick the box.

Are you a: Carer ___  Ex-carer___   Professional____

Concerned relative/friend___

Interested__

I would like to know details about a local contact in:

________________________________________(area)


I would like to receive more information ___

I would like to buy
"Caring for the Person with Dementia" ____
(Please enclose cheque for £3.50)

Total amount £_______________
I enclose a cheque/postal order

I would like to pay by Access/Visa
My number is

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ 

Expiry date:  __ __ /__ __ 



Signature ________________________________   Date ____________________

I agree to abide by the rules of the Society. Copy available on request.

Please return the completed form to 
   Alzheimer's Society,
   Freepost,
   Gordon House,
   10 Greencoat Place,
   LONDON
   SW1P 1W