Sanaton Association
 48 Patriot Square
 LONDON E2 9AN
 United Kingdom

 Company No. 3376786
 Charity No. 1075313

TITLE (MR/MRS/MS):........................................

SURNAME:.......................................................          FIRST NAME:.............................................................

DATE OF BIRTH (DD/MM/YYYY):...................................

RELIGION:.......................................................           NATIONALITY:...........................................................

ADDRESS:............................................................................................................................................ ...

             ......................................................................................  POST CODE:......................................

TELEPHONE:..........................................................   MOBILE:.......................................................

EMAIL ADDRESS (OPTIONAL):....................................................................................................................

I wish to become a member of the Sanaton Association and solemnly declare that I will abide by the rules and regulation of the Association.
 

SIGN:..............................................................          DATE:......................................

Print the form and return by post to: Sanaton Association, 48 Patriot Square , LONDON E2 9AN