| Name: |
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| Address: |
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| E-mail: |
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| Phone: |
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| Would you be interested in any of the following (Please tick): | |
| Events/ Publicity | Secretarial |
| Fundraising | Merchandising |
| Schools' Project | Office |
| Fostering | Supporting Member Only |
| Other (Please write): | |
| Membership Fees: | |
| Adult: €10 | Family: €15 |
| Unwaged / Retired / Under 16yrs: €5 | |