Membership Application

Your First Name(*)

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Your Last Name(*)

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Your Phone

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Would you like to add children to this membership?(*)

Yes

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Your Email(*)

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Country / County of Birth

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Your Date of Birth

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Please provide children's name, place and date of birth(*)

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Your current address(*)

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Postcode / ZIP / Eircode(*)

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Receive Emails?(*)

Please add me to the email list

Please DO NOT add me to the email list

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Interests

Occupation(*)

You can state 'none' or 'retired' if you like

Interests

Sport

Music

Dancing

Other

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Other Interests(*)

What are your other interests?

Volunteering

I am interested in volunteering

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What would you be interested in volunteering for?(*)

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Membership Fee(*)

Adult ($20 per annum)

Senior ($10 per annum)

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You can add an optional extra message here

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Use this form to apply for membership of the Christchurch Irish Society