Registration Form

Registration Form – Pay over 12 months

We’re looking forward to seeing you in the community.

Please take a moment to sign up and let us know a bit about you. Please take care when completing the ‘Name’ fields:

Name: This is where you put your real first name and surname.

User Name: Your user name is the name that you will be known as in the community. If you are nervous sharing about mental health and prefer to be anonymous, this is where you can choose a different name. Members are not able to change this themselves after registration. It is helpful if you include your first name in your User Name so we know what to call you, so for example Sam4678 rather than Redwoolysocks9876 for example 🙂

To help us grow the community and reach as many people as we can, and enable us to apply for funding, it would also be great if you can let us know your gender, ethnicity, disability and access needs.

Prefer to pay in full click here

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Date of Birth(Required)

How Did You Hear About Our Community?(Required)

Disability

Gender

Ethnicity

Email(Required)

Phone(Required)

Username(Required)

We are unable to change this after registration

Display Name(Required)

This is the name other community members will know you as

Password(Required)

Enter Password Confirm Password

Strength indicator

Monthly Fee £5: After your FREE 30 day trial, your card is charged £5 a month on a rolling contract

Price: £ 0.00

Pay with your Credit Card via Stripe Checkout(Required)

Card Details

Cardholder Name