Klinefelter's Syndrome Association (KSA)

Membership Level change

You have selected the Full Member (Non-UK 2 Years) membership level.

	Full membership benefits
	AGM voting rights
	No immediate access - approval required

Approval Required: you will be required to supply evidence of being domiciled outside of the UK in order to qualify for this membership level.

The price for membership is £22.00.

Membership expires after 2 Years.

Account Information Already have an account? Log in here

Username

Note: Any nickname or your email address

Password

Confirm Password

Note: Your password must be at least 8 characters long and contain upper and lowercase letters, a number and a special character like /?.,*&~_+-={}[]\

First Name

Last Name

Email Address

Full Name LEAVE THIS BLANK

Make a Gift

Donation Amount

The KSA is run entirely by volunteers and depends heavily on donations to carry out its important work. 100% of all donations go towards raising awareness and supporting those affected by KS/XXY. If you would like to make a donation, however small – or large! - please enter amount here. Thank you very much.

Gift Aid

Gift Aid legislation allows us to reclaim 25p of tax on every £1 that you give on your subscription and additional donations. It won't cost you any extra.

Allow Gift Aid to be collected?

Address and Contact Details

Please enter details of the principle account holder, that is, the paying member:

Address 1

Address 2

Town/City

County

Post Code

Country

Telephone

Mobile

Additional Information

Are you the person with KS/XXY?

Yes

Your relationship to the KS/XXY person

Other relationship

First Name

Last Name

Karyotype

Other Karyotype

Date of Birth

Note: if unborn, please provide approximate date.

Additional Accounts (Optional)

As an additional membership benefit, you can specify here up to two free additional accounts for other family members e.g. a partner, grandparent or young person who is KS/XXY. They will have the same access to our website, receive the same newsletters and event notices as the principal account member.

Do you require additional [free] membership accounts? (Max: 2)

Yes

Optional Account (1): Please describe the relationship to the KS/XXY person

Other relationship (1)

Username (1)

First Name (1)

Last Name (1)

Email Address (1)

Optional Account (2): Please select the relationship to the KS/XXY person

Other relationship (2)

Username (2)

First Name (2)

Last Name (2)

Email Address (2)

Our Privacy Policy

We take the protection of your private information very seriously. Please refer to our privacy policy for more information on what information we store, why and for how long.

By continuing checkout you are agreeing to your information being processed as described in our privacy policy. If you do not agree, please do not continue to checkout.

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