Member Activation Form (Defunct)

Name

First

Last

Address

Please enter the address at which you recieved your letter to include County.

Name Éireann' with

E-mail address

Please use the e-mail address with which you used to sign up.

Contact No.

Please use the number on which you wish to be contacted.

Confirmation Code

Please enter the code from the letter you received.

'I wish to become active with Clann Éireann'

Please confirm your intent to become an active member of Clann Éireann