Register your interest form

"*" indicates required fields

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

Other

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.

Name

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