Register Log in to renew or change an existing membership. Please select *(Required) I am an amputee I am the parent / carer of an amputee I am a Healthcare Employee TROOPER (Amputee) DETAILS Full Name Name commonly known as Contact Tel. Number *(Required) Home Address *(Required) Area *(Required) Post Code *(Required) Which gender do you identify as? *(Required) Male Female Non-binary Other Prefer not to say If you answered other above, please specify How did you hear about FYF? *(Required) Date of Birth *(Required) Local Authority Area Which hospital carried out your amputation. What year was your amputation GP Name, Address & Tel. Do you have any form of professional support? E.g. Mental Health Care Team, Social Worker etc... Yes No If you answered yes above, would you like to tell us a bit more about the support you have available. Reason for Amputation *(Required) Diabetes Accident Sepsis Congenital Cancer Meningitis Vascular Other Would you like to give us more information about your reason for amputation? What is the level of your amputation (please tick all relevant boxes) *(Required) Right Arm Right Arm Above Elbow Right Arm Below Elbow Left Arm Left Arm Above Elbow Left Arm Below Elbow Right Leg Right Leg Above Knee Right Leg Below Knee Left Leg Left Leg Above Knee Left Leg Below Knee Any additional Limb Information Mobility (please tick all / relevant boxes) Prosthetic(s) Wheelchair Crutches / Stick(s) None Emergency Contact Name, Tel & Relationship (Required information for all Club Attendees) Have you joined our No LIMBits Facebook Group yet? *(Required) Yes No Not yet I'm not sure what this is Any other information FAMILY MEMBER / CARER DETAILS (if registering on behalf of an Amputee) Relationship to Amputee Contact Tel. Number *(Required) HEALTH CARE WORKER DETAILS Organisation you work for Job title Photo Permission - From time to time we'll take photos & videos during our Clubs. Please tick to show you give us permission to use your photograph / video for promotional purposes. *(Required) Yes No We record the information you give us in a secure database. This allows us to keep in touch with you and let you know about the exciting things FYF has available for you to get involved in. We will not give any of your details to anyone outside Finding Your Feet without your consent. You can get in touch to ask for your details to be removed at anytime. Please tick the box to confirm you acknowledge this. *(Required) Please tick to confirm Website Log in Setup Username Email First Name Last Name Password Password Again Troopers - free - unlimited Accept our Privacy Policy? Auto Renew