Your donation will make a difference:
Cystic Fibrosis Trust

Join the Sixty Five Roses Club

Join the Cystic Fibrosis Trust’s Sixty Five Roses Club by filling in the form below.

Please complete the form below to register your interest in joining the Sixty Five Roses Club, and don't forget to tell us a little bit about your reasons for joining. We will get in contact with you shortly with more information on joining the club and how you can make a payment.

Please note that this form will only allow you to register your interest so that we can contact you to discuss your membership - you will not be able to make a payment by using this form. If you have any questions about the Sixty Five Roses Club, please email sixtyfive@cysticfibrosis.org.uk.

Email
*
Phone number
*
Title
Any other questions?
*
Name
Forenames
*
Surname
*
Address
Postcode
*
Address line 1
*
Address line 2
Address line 3
Address line 4
Town
*
Any other questions?
Is there anything else you would like to tell us?
Contacting you
Please choose one of the following