Online Order Form

Please fill in the resources and quantities you require and your details in the relevant sections below:

* denotes a required field

Description
Quantity
 
'Know the symptoms' A4 Poster(s)  
'Check the symptoms' Fridge Magnet(s)*  
'Check the symptoms' Wallet-size Card(s)  
'What you need to know about meningitis' leaflet(s)    

* Orders of over five fridge magnets will be charged at 50p per magnet. Please send a cheque made payable to ‘Meningitis UK’ or phone 0117 373 7373 to pay with a credit/debit card. Your magnets will be despatched on receipt of your payment.

 Name: * *
Organisation:
Address: *
 
Town:
County:
Postcode:*
Tel No :
Email:*
 
Have you experienced meningitis within your family/circle of friends?
If 'Yes', please give further details

Are you an existing supporter of Meningitis UK?

If 'Yes' for how long have you supported the charity?

If 'Yes' why do you support the charity?

How did you first hear about Meningitis UK? *

If 'Other', please specify:

   

 

 

MeningitisUK is the working name of Spencer Dayman MeningitisUK · Registered Charity No.1076774

Spencer Dayman MeningitisUK · Terms & Conditions © Meningitis UK 2005