WEXFORD PPN MEMBERSHIP FORM

If you have any queries, please contact Wexford PPN Support Officer on 053- 9196553 or e-mail ppn@wexfordppn.ie

Community Organisation/Group Details

Name of Community/ Voluntary Organisation/Group

Date your group was established

This must be a dd/mm/yyyy

Number of members

Legal Form of your group (Please select one)

If other group structure, describe

Aims of your community group/organisation

What is the main cause of your group

Does your group...

Have rules or a constitution

Hold an AGM

Have a Bank/Credit Union/Post Office Account

Is your group...

Volunteer led under voluntary control	Not for profit
Active in County Wexford	Open to new members
A single issue group	A member of or affiliated to a national body

If yes - which body

Your groups online presence (if any)

Website

Facebook

Twitter

County Details

In which Municipal District (MD) is your group located?

In which geographical area does your organisation provide services?

Specify if other

Electoral Colleges

Environmental
An organisation whose primary objectives and activities are Environmental (i.e. ecological) protection and/or environmental sustainability.

Social Inclusion
An organisation whose main activity centres on working to improve the life chances and opportunities of those who are marginalised in society, living in poverty or in unemployment using community development approaches to build sustainable communities, where the values of equality and inclusion are promoted and human rights are respected.

Community
All other organisations including Sports, Local Development, Social, Culture, Special Interest etc.

What electoral college does your group wish to register for?

Please read the description for each of the 3 colleges.

Nominated contacts and voting representatives

The persons identified will be deemed as the main and alternate contacts for your group and they will be the contacts to which we provide information for your group. It is the responsibility of the contacts to disseminate the information to the other members of your group and so this should be considered in the choice of your contact personnel.

These contacts are also considered the nominated voters for your organisation, one of which will have voting rights for your organisation/group at each eligible election.

Please note when choosing your representatives that each person can only vote once, even if they are the nominated representative for two groups. Because of the separation of the functions of Public Representatives and the PPN, Councillors, TDs, Senators & MEPs should not be a point of contact or nominated representatives for organisations.

Please ensure you have consent from nominated representatives before providing details.

Main contact

First Name

Last Name

Position in organisation

Mobile Phone

Landline Phone

Address

Town/Area

County

Eircode

Alternate contact

First Name

Last Name

Position in organisation

Contact Mobile

Contact Email

Note: should the representative change you should notify us in writing (email/hard copy)

Declaration and Consent

PPN requirements

Please tick this box to confirm your group meets the PPN requirements

(see requirements on ‘membership’ section of website http://wexfordppn.ie/?page_id=242)

I, on behalf of my organisation, agree and consent to personal data and special categories of personal data which I have provided for main and alternate contacts, and for my group/organisation being used by Wexford PPN or its agents* for the purposes of the Network. This may require my personal data being supplied to and discussed with other members of the Network. Wexford PPN, its agents, and network members will be required to comply with the General Data Protection Regulation – Regulation (EU) 2016/679 of the European Parliament and of the Council. I understand that I may request Wexford PPN to grant me access to my personal data which Wexford PPN holds.

*Wexford PPN currently uses Form Assembly (online form builder) to collect data, Wexford County Council to store data, and Salesforce as a CRM/Database management solution.

Acceptance and consent

Please tick this box to confirm acceptance and consent

Declaration and Consent

I understand that I have the option at any time to withdraw my agreement / consent to such usage as specified above as provided for in Articles 7 and 8 of the GDPR

I confirm that the information on this membership form is correct and that full consent has been received to provide personal contact information

Submission Details

Submitted by (name):

Position in Organisation:

Important Note:

Only groups registered with Wexford PPN will have voting rights for elections.

Your Rights Under GDPR