Membership

Society Annual Membership

Membership details

RenewalNew Membership

Title (required)

If other, please state:

First name: (required)

Surname: (required)

Address: (required)

Postcode: (required)

Contact telephone:

Email: (required)

Membership options

Membership type (required)

Gold - £20Gold concession - £5

Relationship to autism

Please select from the list (required)

If you selected other, please specify.

Relationship to NEAS

Please select from the list below (required)

If you selected other, please state

Why are you wanting to become a member? (required)

Why is this information needed?

Letting us know your relationship to autism allows us to understand the diversity of our members. It also allows us to tailor the information we send to suit your individual needs.

Preferred payment method

Paying by Direct Debit is the most convenient way to pay for your membership. You can cancel at anytime and are covered by the Direct Debit guarantee. (required)

Thank you

Thank you for taking the time to complete this form.

Please note that all application are subject to approval by the Board of Trustees. We will be in touch shortly to set up your preferred payment process.

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