PSPA Online Join Us Form for Health and Social Care Professionals (HSCPs)

Once we have received your form we will send you an introductory email. We aim to communicate mainly by email as this is more cost effective for us.

Contact Details

Salutation

First Name

Last Name

Preferred Name (nickname)

Job Title (if not listed, please select 'Other') & state below:

Other Job Title

What area/region do you cover?

Work Address Street

Work Address Town / City

Work Address County

Work Address Postcode

Work Email Address

Mobile Number

Work Phone

Preferred Phone

How did you hear about PSPA

Introduction From

Further Information

Sex

Pronouns

Ethnicity

Could you help us with our work?

PSPA is interested in working with HSCPs to further awareness and understanding of PSP & CBD. If you feel you can contribute to any of the activities below and would like to help us then please tick the appropriate boxes:

Communication Preferences

We would like to continue to keep in touch with you to tell you about the vital work we do for people with PSP or CBD, our fundraising activities, and opportunities to support us as well as the services we provide.

Please select all the ways you would like to be contacted:

I would like to receive communications by email

I am happy to be contacted by phone

I do not wish to be contacted by PSPA

You can change your marketing options at any time by contacting us by email: consent@pspassociation.org.uk; telephoning us on 01327 322 410; or writing to us at PSPA, Margaret Powell House, 415a Midsummer Boulevard, Milton Keynes, MK9 3BN.

Registered charity number England and Wales 1037087 and Scotland SCO41199

Contact Information