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Wicklow Triple A Alliance Membership Application Form 2021-22
Your data is used purely for your membership account. Data will be kept in accordance with GDPR. Filling this form is deemed acceptance of the above. You can remove yourself from our mailing list at any time by contacting
tripleawicklow@gmail.com
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* Indicates required question
Your name
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Your answer
Please type your address
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Your answer
Please type your email address. This will be used in all correspondence to you
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Your answer
Phone number (You will be emergency contact no 1)
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Your answer
Emergency contact no 2 (name, phone number, and relationship to the young person)
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Your answer
How many children with additional needs do you have?
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Your answer
Child no 1 age & diagnosis
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Your answer
Child no 2 age & diagnosis (If just one child, move onto the next question)
Your answer
Child no 3 age & diagnosis
Your answer
Child no 4 age & diagnosis (If more than 4 children with additional needs, please state their details below)
Your answer
What activities are you interested in for your child?
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Your answer
What activities/seminars are you interested in for yourself/partner?
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Your answer
|Volunteering- As Triple A Wicklow is a voluntary ran charity by parents of children with additional needs we are stretched for supervision of events. We cannot run events without the support of volunteers. Can you/your partner volunteer to help at events once a year?(Caregivers who volunteer to supervise events are allowed free access to that event block for their child) All volunteers are Garda vetted by Triple A Wicklow prior to volunteering.
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Yes
No
Joining the Committee. It is policy that in order to apply to join the committee a candidate must first be a volunteer for at least 6 months. If you are interested in joining our committee please confirm below, and we will be in touch.
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Yes
No
Where did you hear about us?
Your answer
Membership is €30 per family per year if in employment and €10 per year per family if unemployed or at home caring full time. We accept payments via Paypal and our payments will be taken each April. If you would like to become a member please click on the link below to pay the fee. PLEASE ENSURE THE SURNAME AND EMAIL ADDRESS USED FOR PAYPAL CORRESPOND WITH THE INFORMATION GIVEN ABOVE. If there is a difference with this information please state in the answer box. Many thanks. Once your payment has been accepted please email
tripleawicklow@gmail.com
ensure that you are added to the mailing list and private members forum. We look forward to catching up with you in person at one of our events! The Committee *****To donate to us, or pay for a membership/activities or events - Please click on
http://paypal.me/TripleAAlliance
& type your name & activity in the comments box to ensure receipt. Thank you. Alternatively, you can pay via IBAN IE70BOFI90113293052095 BIC BOFIE2D
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