Logo for BackCare, the Charity for Healthier Backs

Thank you for deciding to join as a BackCare as a Professional to support our work.  

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

Please choose the type of professional application
        BackCare Professional         Graduate Member *

Title

*

Forenames

*

Surname

*

Honours


(as they will appear on your certificate and the website)

Practice name

*

Address

 

Town

*

Postcode

County

Country

Telephone

Fax

Mobile

Email

*

Website

Name to appear on your certificate

Professional qualifications


Medical speciality and special interests:
*
( You may enter up to 250 characters. )

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Medical Assn Membership


(Please provide the name of the organisation and your membership and/or registration number)
Gift Aid Logo
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 28 pence from the Inland Revenue.
So just tick this box. Its that simple.

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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