REGISTRATION FORM

(Fields marked with * are required.)
Details of Community Organisation/Group - part 1
Name of Organisation:*  
Address:*  
Eircode:
Tel:*  
Mobile Phone for text information:
Email:
Website:
Facebook:
Describe briefly the objectives, activities and aims of your community organisation/group (max 1000 chars):*  
Date of establishment of your organisation:*  (dd/mm/yyyy)  
What is the status of your organisation?:*info  
Total Membership:  
Which Municipal District is your group in?:*  
Membership Type:*info  
Date of Last Annual General Meeting:  (dd/mm/yyyy)
Name of Public Contact:*  
Public Contact Address:*  
Public Contact Tel:*  
Public Contact E-Mail:
Name of Second Contact:
Second Contact Address:
Second Contact Tel:
Second Contact E-Mail:
Which of the following best describes the primary area of the work of your Group?:*info  
SubCategory:* - (The list of displayed subcategories depends on what has been selected for primary area of work above)  
Please indicate if you are interested in receiving information on other Municipal Districts/Area Of Work Subcategories.
Municipal Districts:


Area Of Work Subcategories:

































Declaration - part 2
To be completed by person to whom all correspondance should be addressed.