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Sign up for membership online

Details of person to whom newsletter and other information should be sent.

Surname * Title (Mr/Mrs/Ms/Other) *
First Name * Tel No *
Address *  
Postcode/Zip code *  

Country *
E-Mail address *  

    * Required

Are you a Person Affected by Encephalitis?
Are you a Family Member of a person affected by Encephalitis?
Are you a clinical professional?
None of the above
As a professional Member you are given a Free place at our CPD accredited Professional Seminar, held in December in London. We will contact you will more details nearer the event.
Please tick if you would like to be involved in:
Presenting at our meetings
Contributing to our information

Relationship to person affected

Details of person who has had an encephalitic illness
– if you are filling in this section on behalf of someone please obtain their consent
Name of affected person, if different from above  
Date of Birth Age at Diagnosis
Virus involved if known  
Resulting problems  

Connections Scheme
You may find it helpful to share your experiences with another Member of the Society. If you would like more information on this scheme please tick this box

We may have a Regional Representative in your area if you are based in the UK.

Please tick the below box if you would like further information on this scheme.


The Encephalitis Society is committed to protecting your privacy and to processing your personal data in accordance with the Data Protection Act 1998 principles of good practice.

As soon as you contacted The Encephalitis Society, we created a record in your name. Information you gave us during any subsequent correspondence was added to that record. This data has been used to provide you with the services, products or information you have requested and to further the aims of our Charity.

Sensitive Data

The type of information we collect might include name, address, telephone number, email address and bank details. We may also collect ‘sensitive data’. This might include such things as: ethnic origin, physical, mental or neurological health. All your personal data are held securely and transfers of data with the Society are on a ‘need to know’ basis only.

If you provide us with personal data, including sensitive data, you consent to us using that data for the purposes for which it is intended. The Society will take steps to ensure that such data is destroyed or removed once the need for keeping it is passed. You have the right to see any information that the Society holds about you, and to have any inaccuracies corrected.