Thank you deciding to renew your support of BackCare.

Please fill in the form below and click the "Submit" button.
After submitting the form you will be able to pay the relevant fee, with a credit card, via our secure ecommerce system.
If you do not wish to pay online, please print the form and post it, with your cheque, made payable to BackCare, to the address below.

Membership Number	* (eg 70000 or FM-70000)
Membership Type	Individual (Ł25.50) Individual (direct debit)(Ł20.50) Individual Concession (Ł15.00) Individual Concession (direct debit)(Ł11.50) Family (Ł30.50) Family (direct debit)(Ł25.50) Overseas (Ł40.00) Overseas DD (direct debit) (Ł35.00) Professional (Ł35.00)
Title	*
Forename	*
Surname	*
Telephone
Email	*
	Use Gift Aid and you can make your donation worth more. If you are a UK taxpayer for every pound you give to us, we get an extra 25 pence from the Inland Revenue. So just tick this box, its that simple.
	* indicates mandatory fields

BackCare
The Charity for Healthier Backs
16 Elmtree Road, Teddington, Middlesex, TW11 8ST
Phone: (44) 20 8977 5474 Fax: (44) 20 8943 5318
Helpline: 0845 130 2704
Registered as National Back Pain Association, Charity No.256751
email: website@backcare.org.uk