Voice membership form

Please complete this form to become a Voice member and receive the Cancer Connect newsletter.

Name
First Last
Address
Street Address Address Line 2 City Postcode Country
Daytime telephone
Mobile phone
Email
How would you prefer to be contacted?
- By email
- By home telephone
- By mobile
Can we say we are from the Macmillan Information and Support Centre and / or Voice if someone else answers the phone? (Due to confidentiality, our number will not be displayed.)
- Yes
- No
I am a:
- Patient
- Carer
- Friend or relative
Consent
I give my consent for the information on this form to be kept on a database in the Macmillan Information and Support Centre at St George’s Hospital. This information will be confidential and will not be shared with any external organisation. I can ask for my details to be changed or removed at any time, without affecting my treatment or care.
- I have ticked the box to confirm my consent