...Making life better for Yorkshire Heart Patients

TAKE HEART
LIFE MEMBERSHIP FORM

Please print this sheet, complete the details and send to

Mr Paul Kaufman
Take Heart
The Yorkshire Heart Centre
F Floor
Jubilee Building
LGI
LEEDS
LS1 3EX
____________________________

Life Membership fee - £1.50 each
Badges - £1.00 each
Life membership is open to everyone

Title (delete as appropriate) Mr & Mrs/Mr/Mrs/Miss/Ms

Forename:

Surname:
Address

Postcode:

Telephone:

I have also enclosed badge fee of £2.00/£1.00 (delete as app)

PLEASE MAKE CHEQUES PAYABLE TO TAKE HEART

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