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Register Form

Please fill in your details below. 
 
Signing up and providing us with your details means you are agreeing to be contacted by ourselves.
 
Pain Association Scotland takes your privacy seriously and will only use your personal information:

·      To provide you with information on the Association’s services.

·      To improve our service and to contribute to research into chronic pain.
 
Under GDPR the details are for our records and therefore won’t be shared with anyone else.
 
A full copy of the policy can be found on our website.
 
* PLEASE NOTE THAT WE WILL EMAIL YOU ONCE WE HAVE RECEIVED YOUR SIGN UP. SO PLEASE CHECK YOUR JUNK INBOX*

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* 1. Below is the sessions times and dates.

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* 2. Title

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* 3. Full Name

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* 4. Address

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* 5. Phone Number

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* 6. Email Address

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* 7. Date Of Birth

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* 8. Who were you referred by?

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* 9. Please give details of who referred you and their address

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* 10. Consent: If you are happy to be contacted by us for future communications which may be of interest to you please select from the following list your preferred method of contact.

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