Uveitis Information Group - Subscription Form

Subscription Form

Please complete the form below

Subscribers will receive an annual UIG News and a copy of "Uveitis", a journal written for both patients and ophthalmologists.

Title

First Name

Last Name

Address
Postcode
Country

Telephone

patient type of uveitis:
carer
ophthalmologist
other (please specify)
Check this box if you are an existing member renewing your membership

Membership costs £10.00. If you wish you may also make a donation to be added to your subscription payment.

Optional extra donation £

Would you like tax to be reclaimed on your donation and subscription under the Gift Aid scheme? (This will boost the value of your donation by 28%).

gift aid

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I would like tax to be reclaimed on my donation under the Gift Aid scheme.

I am a UK taxpayer and pay an amount of Income Tax and/or Capital Gains Tax at least equal to the tax that can be reclaimed on my accumulated donations for the tax year.