PBC Foundation

Join Us

The PBC Foundation provides information and emotional support to families affected by Primary Biliary Cirrhosis. We provide a Helpline and produce a newsletter. We can also try to put you in contact with other members in your area, if you wish.

All information given is confidential and names will only be passed to Regional Co-ordinators, or other members, if permission is granted. No details are passed to any other organisation.

If you have any problems completing this form; please contact us on (+44) 0131 225 8586 or info@pbcfoundation.org.uk.


Title
First Name
Last Name
Postal Address
Country
Post Code/ZIP
Telephone number
Email

Can we pass your details onto our Regional Volunteers (UK Only)?	Yes No

Would you like to receive a list of contacts in your area and be added to the list?	Yes No

How would you like to receive the Newsletter (N.B. Outside UK by Post is £10/$20 per annum)?	Email Post

The following details are optional, but will help us with our research and allow us to distribute information.

Date of birth
Year diagnosed
Other medical conditions

Your Doctor's (or General Practitioner's) Name and address

Your Specialist's (or Consultant's) Name and address

How did you hear about the PBC Foundation?