Disability Power Ireland Membership Form
Thank you for your interest in joining Disability Power Ireland! We're looking forward to getting to know you and your talents!
If you would like to perform or have any event ideas you'd like to organise with us, please let us know!
You can email us with any other information at: disabilitypowerireland@gmail.com
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Would you like to sign the Proclamation of Independent Living? 
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Phone Number
Address
Full Name
Date of Birth
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Why would you like to join Disability Power Ireland?
How did you hear of us?
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Do you identify as disabled, or as an ally?
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How would you describe your impairments?
Are you aware of the social model?
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Would you be interested in volunteering, performing, or taking on a committee role?
How would you like to be contacted?
Are you happy to be added to our mailing list to receive upcoming newsletters with information about our events and other happenings at DPI?
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Do you consent to having your information stored by us in line with data protection legislation? We will only use your information for contacting you about DPI events and getting involved. Your data will not be shared with any third party.
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