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BTG
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Title
Name*
First name Surname
Gender
- Male
- Female
Date of birth*
Date Format: DD slash MM slash YYYY
Parents name
Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Email*
Telephone number*
Transplant recipient*
- Yes
- No
Type of transplant
Other transplant
Transplant hospital
Date of transplant
Date Format: MM slash DD slash YYYY
Which hospita for follow-up?
Connection to patient
Hospital team*
Which hospital Team would you like to join? This could be the hospital you receive follow up treatment, or the hospital where you received your tranplant. Please make sure you check Adult or Children options so we can allocate you to the correct team.
How did you hear about Transplant Sport?
What type of events are you interested in?
- Individual sport
- Team sport
- Social
- Art
- Music
- Other
Would you like us to pass on your name and contact details to the local hospital Team Manager?*
- Yes
- No
I consent to my Transplant Sport Team Manager to see my completed medical form for the events I participate in.*
- Yes
- No
We are often asked for stories to go into the press to promote organ donation, would you be interested in sharing your story with the press? If so, we will contact you when we receive a request for information.*
- Yes
- No
We are a charity supported almost entirely by volunteers with 3 part time members of staff. We are always open to offers of help from our members. As well as donations of time we need individuals who have contacts in the business world eg.. printing, media, marketing, communications, fundraising. If you are able to help, please indicate below: 
- Yes I can help - I have connections / skills / experience in the following... (please specify below)
Details of how you can help
Ethnicity monitoring*
Other ethnicity
Would you like to receive quarterly eNewsletters from Transplant Sport, promoting our upcoming events and our success stories?*
- Yes
- No

Register for the Transplant Sport e-newsletter

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Registered Address: Transplant Sport UK, Black Country House, Rounds Green Road, Oldbury, West Midlands B69 2DG

Registered Charity No. 1127314 | Company limited by guarantee No. 6769099 Registered in England