WATERFORD PPN REGISTRATION FORM

1. CONTACT DETAILS

Organisation

First Name

Last Name

Role in Organisation

Mobile Phone

Website

Address

Area/Town

City/County

Eircode

Please submit details of your alternate contact person below. Please tick the box to confirm you have permission to supply their information to us.

Permission Declaration

I have permission to submit the contact details below

Alternate Contact First Name

Alternate Contact Last Name

Alternate Contact Mobile

Alternate Contact Email

Alternate Contact Role in organisation

2. ABOUT YOUR ORGANISATION

Tell us more about the work of your organisation

What is the main cause of your group

Date your group was established

This must be a dd/mm/yyyy

What Pillar is most appropriate for your organisation

Is your group Governed by rules or a constitution

Please upload your Constition here

What is your groups structure

If other group structure, describe

Is Membership open to everyone

What Municipal District does your group operate in?

Number of members in org

Number of paid staff in org (including CE /Tus)

Number of other staff in org

Number of volunteers in org

How did you hear about Waterford PPN?

Please specify

THE LEGAL STUFF

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