Mr/Mrs/Miss/Ms/Other

First name

Surname

Telephone No

Mobile

Email address*

Postal Address

Postcode*

Name of person with disability      

Date of their birth (optional over 18) 

Disability : spina bifida , hydrocephalus, both

*Required field

To comply with the new General Data Protection Regulations, we need your specific agreement to contact you.

How would you like to hear from us? Please tick as many as you like:

By email?

By post?

By phone?

By text/SMS?

Not at all?           

You can change your choices at any time by filling in the Keeping in Touch form on our website.

If you give permission, we will share your data with national Shine (if they request it) but we will never share your personal data with anyone else.

Shine Surrey helps people living in and around our area. National Shine is a separate, national charity with larger resources who we work alongside. Sometimes they organise events which would be of interest to our members.

I agree to my contact details being passed to national Shine so that they can contact me * (Please answer Yes or No.)

For information on how we look after your personal information, please read our Privacy Policy here.