This form is for new members of Inclusion Ireland. Existing members can renew online Organisation information Name of Organisation * Address * Please enter your full postal address. Telephone * (If you ONLY use a mobile phone then please enter it in the 'Telephone' field) Fax Organisation Email * Description of organisation and service provided * Is your organisation primarily a (please tick) * Service Provider Professional Group National Body Parents & Friends Group Other (please specify) Fee Scale * - Select -Clubs, Trade Unions, Societies, etc. €150.00Up to 100 Members €150.00101 to 250 Members €400.00Over 250 Members €600.00Up to 100 persons €150.00101 to 200 persons €400.00201 to 500 persons €650.00Over 500 persons €1,600.00 Delegate informationShould your organisation be approved for membership at our next board meeting, we will require the name of a delegate for our records. Delegate Name * Telephone * (If you ONLY use a mobile phone then please enter it in the 'Telephone' field) Address * Please enter your full postal address. Mobile * Email * Enter your email address here. Your account's activation email will be sent to this address. You will be asked to set a password during the activation procedure. A delegate is appointed by the organisation, as a representative to attend Inclusion Ireland General Meetings and to vote at meetings. The delegate receives all Inclusion Ireland correspondence and is responsible for passing it on to the organisation. Please enclose a copy of your organisation’s Constitution with the application. Please note once your application has been approved the affiliation fee will be due. To determine what fee your organisation will have to pay please look at our Fee scale by clicking here: Fee Scale 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.