I am over 18 i would like to Join Adult Membership
Please fill out this form if you are an adult over 18 who has Spina Bifida and/or Hydrocephalus and would like to register as a new member.
I am over 18 i would like to Join Adult Membership
Please fill out this form if you are an adult over 18 who has Spina Bifida and/or Hydrocephalus and would like to register as a new member.
Medical condition(s) - please select all that apply
Medical condition(s) - please select all that apply
Any other medical information you wish to provide?
Which is your Community Health Organisation? Please choose your area
Where did you hear about SBHI
SBHI has a team of Family Support Workers, would you like your details to be passed on to the Family Support Worker when completing this form?
SBHI has volunteer Branches covering some counties of Ireland. Are you happy for your details to be passed on to the local Branch if there is one in your area?
Annual Report: Each year Spina Bifida Hydrocephalus Ireland produces an Annual Report for all members. In oder to be as efficient as possible in sharing this document, please indicate if you would like a printed copy sent in the post or a digital copy sent by email
Photo consent: SBHI host many events throughout the year for our members, some of which you or your family may attend. During these events we may take photographs, video recording or audio recording/quoted remarks which include members, their families, volunteers and staff. From time to time, these forms of media are used by SBHI for printed publications or materials, electronic publications of presentations, the SBHi website or the SBHI Facebook pages. In order for us to do this, we are obliged to ask you to select your preferences
I hereby give permission to SBHI to use photos/recordings which may include me, and/or my child and/or my family at various events within the Association throughout the year for promotional material or public information
I am over 18 i would like to Join Adult Membership
Please fill out this form if you are an adult over 18 who has Spina Bifida and/or Hydrocephalus and would like to register as a new member.
Medical condition(s) - please select all that apply
Medical condition(s) - please select all that apply
Any other medical information you wish to provide?
Which is your Community Health Organisation? Please choose your area
Where did you hear about SBHI
SBHI has a team of Family Support Workers, would you like your details to be passed on to the Family Support Worker when completing this form?
SBHI has volunteer Branches covering some counties of Ireland. Are you happy for your details to be passed on to the local Branch if there is one in your area?
Annual Report: Each year Spina Bifida Hydrocephalus Ireland produces an Annual Report for all members. In oder to be as efficient as possible in sharing this document, please indicate if you would like a printed copy sent in the post or a digital copy sent by email
Photo consent: SBHI host many events throughout the year for our members, some of which you or your family may attend. During these events we may take photographs, video recording or audio recording/quoted remarks which include members, their families, volunteers and staff. From time to time, these forms of media are used by SBHI for printed publications or materials, electronic publications of presentations, the SBHi website or the SBHI Facebook pages. In order for us to do this, we are obliged to ask you to select your preferences
I hereby give permission to SBHI to use photos/recordings which may include me, and/or my child and/or my family at various events within the Association throughout the year for promotional material or public information