LHM Membership Form – Adult with a single ventricle heart

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LHM Membership Form – Adult with a single ventricle heart

Your Details

Your Name(Required)
Your Date of Birth(Required)
Address(Required)
Some people use a different name on social media. Providing this will help us speed up your acceptance into our private groups.
Gender(Required)
Please give as much detail as possible here. If you are unsure about the diagnosis, what has your doctor / consultant said?
Max. file size: 10 MB.
Are any relatives/family also members of LHM?
Do you have any children?
Do you have a partner who also wishes to join LHM?

Contact Preferences

Would you like to be put in touch with someone who has shared similar experiences?(Required)
If you would like to receive updates about the work of LHM, including support & information, fundraising and awareness campaigns, please indicate below your methods of contact:(Required)
Where did you hear about us(Required)
Membership Terms(Required)

MEMBERSHIP OF THE CHARITY REQUIRES AN OPEN AND HONEST SUBMISSION OF INFORMATION ON APPLICATION AND DURING THE TERM OF THE MEMBERSHIP