Membership Appllication Form

Membership Application Form

Name:

Address:

Telephone:

Date of Birth

Email:

Please Tick Appriopate Box:

Person with Disability:

Carer:

Do you wish to become an ordinary member (attend a minimum of one meeting or event per year) or associate member (will not be attending meeting but please keep me informed)? Both memberships require an annual subscription of €5/year to assist towards the distribution of our quarterly newsletter and notification of news and events. We will be in touch with you on acceptance of your membership, when we will arrange for payment of your fee.

Ordinary Member:
Associate Member:

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