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REGISTRATION DETAILS

I would like MPD Support to contact me about upcoming events and other programmes. My details are:
Name:
Preferred method of communication email, post, telephone etc:
Details of this (eg. email address):


We are also interested in capturing your views.  Please could you take time to complete the following section
  • How often would you like to have face-to-face meetings:
    (eg quarterly, bi-annually)
  • What day/time would you prefer meetings:
    (eg evenings- weekdays, w/end -daytime)
  • Would you like to hear specialist speakers?
  • Do you have any suggestions for topics?
  • If you prefer your updates by email, how often would you like to receive them?
  • Are there any specific areas you might be interested in becoming more involved with:
    (eg. fund raising, support to newly diagnosed patients, website, provide case study, help with meetings etc)
  • Would you be happy to contribute samples to a national sample bank to speed future research?
  • Would you be happy for clinical information about you and your disease to be held on a private protected database to support such research?
  • We would like to offer Patients' Forums in locations throughout the UK. Would you share your postcode so we can consider scheduling a forum in your area?