Mailing List Application

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First Name(s):
Last Name:
Address:
Address:
Address:
Address:
Post Code:
Telephone:
Mobile:
E-Mail Address:
* Use of your photo image?	Yes No
How did you find out about the group?
Other – please specify:
Comments:

* Photos of group activities are used in publicity material including our web-site.
Are you happy for your image to be used for these purposes?

To comply with the Data Protection Act 1998 the information given is held by Diabetes UK West Lothian voluntary group on a computer file and on paper within Diabetes UK West Lothian voluntary group only to maintain records, distribute information, publish the newsletter and for administration within Diabetes UK West Lothian voluntary group. It will not be passed to third parties for commercial benefit