Benbulben Chronic Obstructive Pulmonary Disease Support Group

 

Expression of Interest Form

 

Please return this form if you would like to be contacted regarding the next support group meeting.

Name______________________________________________

 

Address____________________________________________

                ___________________________________________________

Telephone_________________________

Signed___________________________________________________

                                                                                      (Please tick)

 

   I am interested in becoming a committee member      Yes  –        No   –

 

“Alone we can do so little : Together we can make a difference.”