NASS T shirt

Please print and then Fill in this form for the Car Driving with Ankylosing Spondylitis book

Complete and return this form to: -
National Ankylosing Spondylitis Society
Registered charity no 272258
Unit 0.2
One Victoria Villas
Richmond
Surrey
TW9 2GW

I wish to make a donation to NASS - Donation £..............

Please make the cheque payable to "National Ankylosing Spondylitis Society"

(BLOCK LETTERS: ADD MR/MRS/MISS OR OTHER TITLE)

Date ...................................

Surname .....................................................................................................

Other names or initials .............................................................................

Address ..............................................................................................

Post code ..............................................

Telephone number: Home....................

Do you suffer from Ankylosing Spondylitis?* ..........................................

*This question is asked so that we know what proportion of sufferers

Return to Home Page