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Register to receive our quarterly newsletter Choices and other communications

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Privacy Notice

Before you proceed, we would like to draw your attention to our Privacy Notice.

Your privacy and data protection are of utmost importance to us, and we want to ensure that you are fully informed about how we collect, use and protect your personal information.Please take a moment to review our privacy notice.Privacy Policy

Acceptance

I agree that Carers' Resource may securely store my personal information in line with their privacy policy

I do not agree

Status message

If you do not want us to store your data you will not be able to submit this form and will have to contact us by phone instead. We will not share your details without permission.

Contact Details

Your Details

User Completing Form

I am a

Carer

Professional

First Name

Last Name

Job Title

Street Address

Street Address Line 2

City

Postal Code

Professionals Organisation

Professional Organisation

Please start typing to search for the professionals organisation in the box below. If the name does not appear, click Create New

Organization Name

Type of Organization

GP Surgery

Donor Organisation

Statutory Services - Council

Health - Primary Care

Health - Secondary Care

Palliative Care

Education - Primary

Education - Secondary

Voluntary Sector

Education - Further

Jobcentre/DWP

Former Organisation

Statutory Services - Police

Statutory Services - Fire

Equipment & Adaptations Provider

Utilities

Care Provider

Housing

Commercial Business

Information Service

Education - Special needs

Postal Code

We use your post code to help identify if we already have a record for you on our systems.

Activity

Subscriptions

I would like to receive the Choices magazine

I would like to receive Choices by post/email

I would like to be involved in the Carer Forum

I would like to share my story with others

I would like to receive other occasional emails from Carers Resource

How would you prefer us to contat you?

Phone

Postal Mail

SMS

Relationship to Your Details Start Date

Contact Method

Activity Date

Activity Date: Date

Activity Date: Time

Activity Date

Activity Date: Date

Activity Date: Time

Activity 2

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