Register as a Leeds Mencap Member - Learning Disability Charity

Username*
E-mail*
First Name
Last Name
Password*
Repeat Password*
- Billing Address
- Address*
- Town / City*
- Postcode*
- Phone*
Child's Details
Child's Name
Number of children the equipment will be used for
Age of Children
Child's Date of Birth
Disability/Needs
I agree to the use of feedback provided for promotional purposes*
- I agree
- No thanks
I agree to the use of my photographs for promotional purposes*
- I agree
- No thanks
I agree to the terms and conditions set out by the Leeds Mencap Toy Library*