Register your interest form

• Name
  First name Surname
• Address*
  Address Line 1* Postcode
• Region*
  Region*EnglandScotlandWalesNorthern Ireland
• Email*
• Phone
• Where did you hear about virtual support groups?
  British Liver Trust NewsletterBritish Liver Trust WebsiteHealthcare ProfessionalSocial MediaOther
• Other

• Support Group Information

• Are you?*
  • A patient
  • A carer
  • A healthcare professional
• What type of support groups are you interested in?*
  Tick up to three options
  • General liver disease support group
  • Pre-and post-transplant
  • Genetic & autoimmune
  • Liver cancer
  • NAFLD
  • Alcohol-related liver condition
  • Hepatitis B
  • Young Persons
  • Hepatic Encephalopathy (HE)
  • Carers
• Untitled*
  • I consent for British Liver Trust to process and store this information for the purposes of booking my place onto a virtual support group.

• Keeping in touch

  We would like to keep you up to date with our news and offer you more ways to get involved. If you already hear from us, we will continue to contact you in the same way. If you don’t already hear from us, please tick the box if you are happy to receive updates by:
• E-mail
  • Yes
  • No
• Post
  • Yes
  • No
• Phone
  • Yes
  • No
• Of course, you can change your options at any time by emailing info@britishlivertrust.org.uk. We will never sell or share your data with anyone else and we will keep your information safe and secure. For more information please take a look at our privacy policy.