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CARDIAC NURSE
                                               SPECIALIST HELPLINE
                                               Available on Leeds 0113 392 5645 -
      life                                     Medical and Surgical
      membership                               COLLECTION BOXES

      form                                     If you require a collection box, or
                                               your collection box needs empting.
                                               Contact Alec McLean
      Please complete the following form and return   on 0113 257 6548
      to:   Denise Nash, Secretary
          Take Heart, The Yorkshire Heart Centre,  Or the Take Heart Office
          F Floor, Jubilee Building, LGI,      on 0113 392 2888.
          Leeds LS1 3EX.
      or join online at www.takeheart.net
                                               MORRISH SOLICITORS LLP
      Life membership fee £1.50 each           As Honorary Solicitors, Morrish
      Badges £1.00 each
      Life membership is open to everyone.     Solicitors LLP offers free initial legal
                                               advice to our members and their
      Member 1
      Forename: (Mr/Mrs/Ms) ........................................  families.
      (delete as appropriate)
      Surname: .................................................................  To seek advice telephone
                                               Tom Morrish (Yeadon Office) on
      Member 2                                 033 3344 9609.
      Forename: (Mr/Mrs/Ms) ........................................
      (delete as appropriate)
                                               Charlotte Bandawe (Pudsey Office)
                                               on 033 3344 9607.
      Surname: .................................................................
                                               CHANGE OF ADDRESS
      Address: ...................................................................
                                               Please be sure to let us have full
      ...................................................................................  details if you move house so that
                                               we can keep our database up to
      ...................................................................................  date for posting out newsletters
                                               etc.
      ...................................................................................

      Postcode: ................................................................

      Telephone: ..............................................................
      Date: .........................................................................
      I have enclosed fee(s) of:
      Couple £3.00/Single £1.50.
      I have also enclosed badge fee(s) of £2.00/£1.00
      (delete as appropriate)
      please make cheques

      payable to take heart
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