Book your place at a support session

Your contact details

Your details(Required)

First name Last name

Email address

Phone number(Required)

Date of birth

Your address

Your address(Required)

Address line 1 Address line 2 Town/city County Postcode Country

Your GP details

Please complete this section if you are not registered with one of our Support Professionals

Name

Name of GP or GP Practice

Phone number

More about you

Are you a(Required)

Person with a brain tumour diagnosis

Family member

Carer

Friend

Other

Diagnosis

Can you provide more information?

Can you tell us what support sessions you are interested in?(Required)

Men's support group

Low grade tumours

High grade tumours

High grade family and friends group

Bereavement support group

Other

Of 'other' please tell us more

Do you have any other comments?

We'd love to stay in touch

Without you, we cannot offer the vital support to those who need us. We'd love to keep you informed about the difference your fundraising has made, and would also like to keep you up to date with Brain Tumour Support news and future events. Most of the news we send is via email but if you are happy with any form of contact then please tick as appropriate.

Please tell us how you would like us to keep in contact with you (tick all that apply)(Required)

Post

Phone

Your privacy

The information you’ve provided will only be used to contact you about our support services.

We will not use this or pass the details recorded in this form, or provided to us at a later date, to any other organisation without your permission.

Your privacy is important to us and we treat your personal information with confidence. To learn more about how and why we collect and use any personal or sensitive information about you please read our privacy policy.