Full Membership

Please complete the form below to apply to become a Full Member of PINNT. A payment of £5 is required to become a full member (Please note there is a 50p charge for administering membership online, this covers half the cost that PINNT incur). Membership years run from the 1st May to the 20th April.

If you receive your homecare from Bupa, Calea or Willow Healthcare Service please email info@pinnt.com for a special form - you may be entitled to a sponsored membership fee

Personal Details


Title:
Surname:
First Name:
Address:
Address (line 2):
City:
Postcode:
Tel No:
Email address:
Date of birth:

Payment Options & Donations

In this section please select the method of payment you would like to use in order to pay for your full membership subscription (£5 ,please note there is a 50p charge for administering membership online, this covers half the cost that PINNT incur). Donations will be gratefully received so if you would like to make a donation please indicate how much you would like to donate in this section also.

Payment Type:
I would like to to make a donation:
Donation Amount (£):
Gift Aid Donation:	By ticking this box you are declaring that you are a UK taxpayer and would like PINNT to reclaim the tax on your donation and any further donations made to them. Full terms can be read here.

Additional Information

Type of treatment:	Intravenous Naso Gastric Gastrostomy Jejunostomy
Date nutrition therapy commenced:
Hospital(s) attended for your artificial nutrition therapy:
Name of consultant:
Conditions Necessitating Treatment:
Would you be willing to act as a contact for fellow PINNT members:
If I write an article for the magazine I am happy for it to be used on the website:

Confirm Subscription

	PINNT is a registered Data Controller as defined under the Data Protection Act 1998. Data will be managed according to the governing law. We draw your attention to the fact that PINNT use electronic forms of data storage. If you require information on our retention policy please contact PINNT.

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