PPN Registration Form

Basic Information

Group/Organisation Name

Address

Area/Town

City/County

Eircode

Website

Twitter page

Facebook page

Main Contact Details

First Name

Last Name

Mobile Phone

Phone

Alternate Contact Details

Please note - in accordance with GDPR - if you are supplying details of your alternate contact, you must have permission to do so.

I confirm I have permission to provide the details below.

Alternate Contact First Name

Alternate Contact Last Name

Alternate Contact Mobile

Alternate Contact Phone

Alternate Contact Email

Group Information

Please tell us Municipal District of your organisation

Select the Pillar your group wishes to join

What is the main cause of your group

Tick here if your group is providing services on a countywide basis?

Tell us about the work of your group

Date Established

Date of Last AGM

Governed by rules or a constitution

Group's structure

If other group structure, describe

If you are affiliated to an umbrella group/national body, please specify

Is Membership open to everyone

Number of members in org

Number of volunteers in org

Number of paid staff in org

Number of other staff in org

The Legal Stuff

Name of Submitter

Submitter Position in Organisation

I give consent for my information and my organisations information to be processed in line with GDPR