Adult with TM

Use this form...

...if you are a person with TM, ADEM or NMO, or you are the contact for an adult with TM, ADEM or NMO.

...from the menu at the top of the page, or return to the Membership front page to review the choices.

Member name *

First

Last

Email *

Telephone *

We will only telephone you if your email address stops working.

Postcode *

Address Line 1 *

Address Line 2 *

Town or City *

Name of person with TM, ADEM or NMO (if different) *

First

Last

Sex *

Male Female

Date of birth *

Year of diagnosis *

Diagnosis *

TM ADEM NMO Other (please specify below)

Other diagnosis *

Contact you urgently? *

Yes, by email Yes, by telephone No

Brief explanation of your urgent query and your contact details *

We are all volunteers in TM Society.
Do you want to help? *

Yes No

You will receive a Welcome email with more information about TM and the UK TM Society in the next couple of weeks.