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About us

Apply for membership online

To join Wokingham Bracknell & Districts Mencap (WBDM) and access our services please complete the form below. Membership runs from 1st January to 31st December each year. Subscription is currently £15 per year.

When your details have been received we will send you details of how to pay.

Data Protection: Wokingham, Bracknell & Districts Mencap will use the information you give us for membership purposes.

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Items on the form in bold must be completed.

Carer's details:

Title
 Mr
 Mrs
 Miss
 Ms
 
First name:

Last name:

Address line 1:

Address line 2:

Town/City:

Postcode:

Telephone:

Email:

Can we use email for mailings?
 Yes
 No
 
If you have any comments or questions for WBDM about your application please write them here:

Your local authority?
 Wokingham
 Bracknell
 Other
 
Please state your ethnic background. This helps us monitor equal opportunities.
 White
 Chinese
 Black/Black British
 Asian/Asian British
 Mixed race
 Other
 Do not wish to say
 
If you selected 'Other' please give details:



Disabled person's details

Title
 Mr
 Mrs
 Miss
 Ms
 
First name:

Last name:

Date of birth:

Nature of learning disability or autism spectrum condition:

If this person has a physical disability please state condition: