Join us

To become a full member of the Association, please fill in your details below or alternatively send your details via email or write to us at the address at the bottom of this page.

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Your Details

First Name*
Surname / Family Name*
Address*
Postcode*
Country*
Phone Number
Mobile Number
Email Address*
Confirm Email Address*

Your Child's Details

Do you have a heartchild?
No Yes
Child's First Name*
Child's Surname / Family Name*
Date of Birth
Heart Condition*
Other Information

Contact Preferences

Newsletters
No Yes

Confirm Entry

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Verification*

Only click once, submitting your membership request may take a short time.
If you have any problems with the above form, please submit your membership request by email instead.

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Children's Heart Association
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