Ehlers-Danlos Foundation of New Zealand

 Name

Address

Phone no

Mobile no

E-mail

        I have:    Ehlers-Danlos Syndrome Type(if known)

                       A family member with EDS Type

                       Hypermobility Syndrome (tick one)

                       A family member with HMS

There are........other members of my family with EDS/HMS

. I am willing to be contacted by other members             (tick one)

. I do not wish to be contacted at this time

 Please find the following amount enclosed:

Individual Subscription of $10.00                                          $

Donation  (optional)                                                            $.

                                                                               Total   $

Please send payment to:

       THE EHLERS-DANLOS FOUNDATION OF NEW ZEALAND
     C/- JEN LONGSHAW, 368 BUTLER ROAD, R.D.43, WAIPAWA, 4273, HAWKES BAY, NEW ZEALAND.

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