Friends 0f the Manx Diabetes Centre

You may register or renew your membership on line
Please enter your details below

I wish to become a member of the Friends of the Manx Diabetes Centre
A Registered Charity in the Isle of Man Number 894
I understand and agree that all monies donated to the group will be used for
the benefit and welfare of diabetics and their medical carers on the Isle of Man,
unless otherwise requested in writing by the donor

Please enter my name on your mailing list: I do not wish to be on your mailing list:
Membership Options:
Name:
Address:
Country:
Postcode/Zip code:
Telephone:
Fax:
e-mail:
I am not diabetic: I am diabetic:
Type 1: Type 2:
Treatment : diet: tablets: insulin:
Special Instructions:

You may also complete and print this form and post it to
The Membership Secretary, 39 Cronk Drean Douglas
along with your cheque made payable to "The Friends of the Manx Diabetes Centre"