Order My journal To order your copy of My Journal - Life after childhood meningitis and septicaemia please fill in the form below. One of our services team will contact you for further information once you have submitted your details. Order My journal Personal details TitlePlease select... Mr Mrs Ms Miss First Name Last Name Phone Whichever is your preferred number Email Address Street address Town County Postcode My Journal details Who has had meningitis?Please select... Myself Son Daughter Wife Husband Mother Father Relative Other Type of meningitis (if known)Please select... Viral Bacterial (type unknown) Group B streptococcal (GBS) Meningococcal meningitis Meningococcal septicaemia Meningococcal meningitis & septicaemia Phneumococcal Other Approximate date of illness Age now Outcome/ After-effects Your meningitis experiencePlease select... Personal experience Family experience Friend/Neighbour experience Nursery experience Pupil/Student experience Employee experience Professional experience No experience Reason for contacting usPlease select... Meningitis Experience Worthwhile Charity Community Contact Wish to take part in local event Wish to take part in national event Corporate sponsorship opportunity In Memory-Meningitis death Concern about Meningitis Professional Experience Want to Volunteer Select the way(s) you would like us to contact you We would like to contact you by post, phone, SMS and email to update you about our work and activities. If you are happy to receive this information from us, please tick the relevant boxes:I have selected how I would like to be contacted Post Phone SMS Email No contact Need assistance with this form?