Please note, this form is for people who are EXISTING Members of Inclusion Ireland. New members can join online.Please fill in the form below. Contact informationPlease enter your personal contact information here. Name * Address * Please enter your full postal address. Telephone * (If you ONLY use a mobile phone then please enter it in the 'Telephone' field) Email * Date joined Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year CAPTCHAThis question is for testing whether you are a human visitor and to prevent automated spam submissions. What code is in the image? * Enter the characters shown in the image.