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Apply For Membership 

As an association, our beneficiaries are our Members. The circumstances in which you sustained your injury will depend on which membership category you fall into, but this does not affect the support you receive.

Fill out this form to enquire about becoming Member of Blesma. The form will go to our membership team who will oversee your application from there.

To complete this form you will need the following....

    • A copy of one of the following documents: Veterans ID card, Certificate of Service/War Pension or AFCS entitlement letter.
    • If you do not have this information please also fill out the Data Disclosure Authority form so Blesma can verify your service. 
    • Your NI number
    • Details of your service 
    • Your NHS number
1

Your Details

STEP 1/5
is a mandatory field
DD/MM/YY
We use this number when communicating with NHS services, such as Hospital transport or GPs and it allows us to identify you to such services securely in written communications without using patient identifying information. You should be able to find your NHS Number on any letter or document you have received from the NHS, including prescriptions, test results, and hospital referral or appointment letters. If you cannot find your NHS Number at home, you can ask your GP practice to help you.
DD/MM/YY
2

Service Details

STEP 2/5
Veterans / Service ID card, Certificate of Service/Discharge Certificate, War Pension or AFCS entitlement letter (photographs of the document(s) are acceptable)






DD/MM/YY
DD/MM/YY
3

Details of Disablement

STEP 3/5

3. DETAILS OF YOUR DISABLEMENT

a. Amputation

If non applicable please state "N/A"
Please advise type and cause of amputation/s. If non applicable please state "N/A"
Please advise date of amputation/s
If so, please provide details

b. Loss of Use

Please advise how you are affected. If non applicable please select "Non Applicable"
4

Details of Any benefits or Supplementry Allowances

STEP 4/5

4. DETAILS OF ANY BENEFITS OR SUPPLEMENTARY ALLOWANCES

Do you receive any of the following?

Declaration

I authorise Blesma The Limbless Veterans and its agents to act on my behalf and grant them full authority to discuss, disclose and receive personal and confidential information from Veterans UK, Department for Work and Pensions and NHS. I note that Blesma reserves the right to carry out checks in relation to my service. I authorise Blesma The Limbless Veterans to use my details to make contact, pass information, advice and Association material and provide support, prevent fraud, and comply with legal obligations.
I also do hereby undertake to pay the sum of £1.00 if Blesma The Limbless Veterans was ever to be wound up. Please consider this application for membership and I agree to abide by the Constitution and Rules and Code of Conduct. Please see below the Code of Conduct in full.
As Blesma is a Membership Association successful applicants will be required to pay a Membership Subscription Fee which is £1 (one) on joining and £1 (one) per year thereafter OR a one off life payment of £2 (two) pound's on joining. This will be collected once membership is confirmed in writing and details of how to pay this will be contained within the Welcome Letter sent to new members.

 

 

Prefer a paper form? If you prefer a printed version of this form click here and return with copies of any supporting documents to Freepost BLESMA

 Looking for our Constitution? To read Blesma's Articles of Association and Rules in full click here

To read our Code Of Conduct in full click here

 

Prefer a paper form?

If you prefer a printed version of this form click here and return with copies of any supporting documents to Freepost BLESMA.