Members : Application

1

I agree that any information I submit can be used to process my membership, and to provide me with the services I will receive. I understand that the DABBGL will hold my personal information on their systems for no longer than is necessary to deliver those services or fulfil any legal or safeguarding obligations.* This field is required.

I agreePlease contact me to clarify

2

Choose the membership type* This field is required.

1 Year Individual/Family/Organisation membership (£15.00)

4 Year Individual/Family membership (£50.00)

1 Year Individual/Family membership for low income household (£8.00)

3

Donation* This field is required.Would you like to give an optional donation (in addition to the membership fee)?

Yes pleaseNo thank you

4

Thank you for your donation* This field is required.Please specify the donation amount (in £'s) you would like added to your membership fee.

5

Do you wish to Gift Aid your payment?* This field is required.Gift Aid is a government scheme which increases your gift to us by 25% at no extra cost to you. You need to be a UK taxpayer and pay more money in income tax, than the amount that you Gift Aid each year. If you opt-in by selecting "Yes Please", the arrangement will continue until you notify us otherwise.

Yes pleaseNo thank you

6

Your name* This field is required.If you selected Gift Aid, we will need your full first and last names please, NOT an initial

Title

First Name

Last Name

7

Your address* This field is required.

Street Address

Town

County

Postcode

Country

8

Your telephone number* This field is required.

Area Code

Phone Number

9

Your email address* This field is required.

10

How would you like us to send you the DABBGL newsletter?* This field is required.

By email

By post

11

How would you like us to send your membership renewal?* This field is required.

By email

By post

12

Would you like to join our mailing list to receive details of our dyslexia events and items of interest?* This field is required.You may unsubscribe from these emails at any time in the future.

Yes pleaseNo thank you

13

Have you previously signed up to join our non-members mailing list (via the Events page on our website?If Yes, you will be removed from the non-members mailing list to avoid you receiving duplicate emails from us

YESNO

14

Would you like the added benefit of a BDA affiliation?* This field is required.DABBGL subscription currently entitles you to a British Dyslexia Association (BDA) affiliation*. This means you will receive BDA communications and their Contact magazine. To receive this added benefit, your contact details e.g. name, postal address, email address will be forwarded to the British Dyslexia Association. *Access to this benefit may change or be withdrawn mid-subscription if the DABBGL are instructed to do so by the BDA.

Yes pleaseNo thank you

15

This is your total fee to payIncludes your selected membership type + donation

16

How would you like to pay?* This field is required.

Electronically by bank transfer

Posting a cheque

17

Electronic payment
Please note that you will not be able to make an online payment directly from this form.

Please set up your bank transfer using the following details, with "MEM {yourName}" as the payment reference:

Account name: DABBGL

Sort code: 30-91-35

Account number: 03369067

Please be aware that your membership will not be processed until payment is received.

18

Postal payment

Please make your cheque payable to DABBGL and send (with a printed copy of the confirmation email you will receive) to:

Dyslexia Association of Bexley Bromley Greenwich & Lewisham,
Community House,
South Street,
Bromley,
Kent BR1 1RH

Please be aware that your membership will not be processed until payment is received.

19

Can you help us ensure we provide the right services?This question is for statistical purposes only - please click all that apply. You may leave this question blank by clicking "Next" without making a selection if you wish.

I am an adult dyslexic

I am a parent

I am an SpLD teacher

I am a teaching professional

I am a medical professional

Other

20

What are the ages of your dyslexic children (if applicable)?This question is for statistical purposes only. You may leave this question blank by clicking "Next" without entering any details if you wish.