Your incentive – Online Survey

Thank you for taking part in the online research regarding caring for elderly relatives - your feedback was really appreciated.

Your incentive of £20 can be received via amazon voucher (will be emailed to you) or Paypal Payment

Please fill in your details below to indicate which payment method you prefer, and make sure all are correct and up to date

None of this information is ever passed onto any third parties and stored securely

Many thanks,

The Members Team

Your Contact Details

Your Contact Details

First Name *

*THIS IS HOW WE HAVE YOUR NAME WRITTEN ON OUR DATABASE*

Surname *

*THIS IS HOW WE HAVE YOUR NAME WRITTEN ON OUR DATABASE*

Daytime Contact Telephone Number *

*THIS IS THE DAYTIME CONTACT NUMBER WE HAVE FOR YOU - PLEASE CHECK THIS IS CORRECT*

Alternative Contact Telephone Number

Email Address *

*THIS IS THE EMAIL ADDRESS WE HAVE FOR YOU - PLEASE CHECK THIS IS CORRECT*

Would you prefer to be paid directly into your Paypal account or prefer to receive an Amazon Voucher (amazon voucher is emailed to you)

* PaypalAmazon Voucher

Paypal

FULL NAME linked to your Paypal account *

EMAIL ADDRESS linked to your Paypal account *

TELEPHONE NUMBER (if applicable) linked to your Paypal account

Amazon Voucher

FULL NAME *

EMAIL ADDRESS linked to your Amazon account *

Δ