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I am pledging for
Myself (my name will appear on the pledge)An Organisation (the organisation's name will appear on the pledge)

Which statement describes you best?
I am a carerI am a former carerI am a politicianI work/volunteer with CarersNone of the above, but I support your cause

Organisation name

Type of organisation
Carers groupCharity or local voluntary organisationBusiness/employerLocal authorityCCGGPNHS hospital trustPharmacyOther NHS serviceHospiceResidential home careDomiciliary care serviceEducation providerTraining providerShop/supermarketYoung carers organisationFaith groupLeisure centreOther - please specify below

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