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Become a member
Not yet a SCTI member? Members of the SCTI help to bring our programs to life and fulfill our mission of supporting those living with sickle cell disease. (Any information contained on this form is strictly confidential)
ACCEPTANCE OF MEMBERSHIP IS ENTIRELY AT THE DISCRETION OF THE BOARD AND BECOMES EFFECTIVE FROM THE FIRST BOARD MEETING AFTER APPLICATION, IF APPROVED.
Please fill the form below with the relevant information.
First name
*
Last name
*
Email
*
Mobile
*
Date of Birth
*
Are you a Sickle cell sufferer?
Please select Yes or No
Yes
No
Family member of sufferer
Please select Yes or No
Yes
No
Sickle cell carrier or trait
Please select Yes or No
Yes
No
Are you a Supporter?
Please select Yes or No
Yes
No
Are you an Organisation
Please select Yes or No
Yes
No
AT ALL TIMES I AGREE TO ABIDE BY THE RULES AND REGULATIONS OF SICKLE CELL AND THALASSAEMIA IRELAND AS SET OUT IN THE MEMORANDUM AND ARTICLES OF ASSOCIATION.
Do not enter anything in this field:
*
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Please fill this field.