If you would like to register with the TBPI Group, and receive Newsletters about the group, website updates and other BPI related stuff, please fill in this form and click on the SUBMIT button. The Newsletter will hopefully be emailed to you regularly about every 6 weeks although I can't guarantee it!  The form is in three parts; the first part is for everyone to fill in. The second part is only for people with a BPI , and the last part is for other visitors, for example, parents of someone with a BPI.

Please enter your name

Email address (please; not Hotmail...why?)

Address line one

Town or City

Zip or Postcode

Country initials e.g. "U.K."

Date of birth

Your gender

Do you have a Brachial Plexus injury?

If you do not have a BPI yourself, but you would like to receive Newsletters and/or take part in any future surveys, please go to this section  > CLICK HERE

If you clicked on 'yes' to the last question, Please answer the following questions. We aren't being nosy, but the answers you give will indicate what kind of information would be useful to you in a Newsletter.

Please click on the button that best describes your injury

Date your injury ocurred or was first noticed or diagnosed

Would you be happy to take part in any on-line surveys on this site about BPI ?

Are you able to receive HTML Emails?

THANKS for filling in the form! Click HERE to go to the RESET and SUBMIT buttons and to read the privacy statement.

Please do not use a Hotmail account unless it is the one you use regularly. Because the Newsletter will only be emailed to you once every six weeks or so, unless you use your Hotmail account at least once in 30 days, it gets deleted.

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PRIVACY STATEMENT; The authors of this website and the Committee that runs it promise that ANY information collected in this form will NOT BE PASSED ON TO anyone. ALL data will be kept on a secure computer that is never connected to the internet. We shall of  course comply with the Data  Protection Act (U.K.) 1998 if it applies.

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CLICK the reset button if you want to clear the form and start again...

CLICK the submit button to send your answers. Please don't submit the form more than once. It gets me confused!

These next few questions are for all visitors who want to register but do not have a Brachial Plexus injury.

Are you one of the following; (Please click one of the statements in the dropdown list below)

Age of your child/friend

Date of injury to your child/friend

Would you be happy to take part in any online surveys on this site about BPI?

Are you able to receive HTML email?

Thanks for filling in the form! Please read the Privacy notice below.

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MALE
FEMALE

YES
NO

Trauma BPI
Obstetric BPI
BP Related e.g TOS
Undiagnosed

YES
NO

YES
NO
DON'T KNOW

SELECT ONEThe parent of someone with an OBPIThe parent of someone with a TBPIOther relativeFriend of someone with a BPIPhysiotherapistOccupational therapistOther therapistMedical practitionerOther

YES
NO

YES
NO
DON'T KNOW