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:

We would like to keep you informed about our work. Meningitis UK is committed to protecting your privacy and adheres to the Data Protection Act 1998. If you would prefer not to receive this information, please tick this box.
To help us recruit new supporters, we may occasionally exchange lists with like-minded organisations. If you do not wish to be included, please tick this box.

Awareness Programme

Online Order Form