This form is for young people with alopecia aged 13-17, living in the UK who want to join the Alopecia UK Youth Network.

The form consists of 3 sections:
1. Tell us about you
2. Consent from a parent or guardian
3. Equality and Diversity form (optional)

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* 1. First Name

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* 2. Surname

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* 3. What type of alopecia do you have?

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* 4. Email Address

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* 5. Phone Number

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* 6. Date of birth

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