Two Voting Members

Please fill in the following form to register for your membership.

Membership Options(Required)

Membership Price

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Person with Down syndrome

Is the Person with Down syndrome the voting member?

Voting members will either be a person with Down syndrome who is 18+ or a close family member of a person with Down syndrome.
The voting member can vote at DSI’s Annual General Meeting. The person with Down syndrome will also be entitled to access branch services.

The first name of the person with Down syndrome(Required)

The surname of the person with Down syndrome(Required)

The first line of the address for the person with Down syndrome(Required)

The second line of the address for the person with Down syndrome

The town of the person with Down syndrome(Required)

The county of the person with Down syndrome(Required)

The Eircode of the person with Down syndrome(Required)

Date of Birth of person with Down syndrome(Required)

Email address of person with Down syndrome(Required)

Phone number of person with Down syndrome(Required)

Branch of person with Down syndrome(Required)

Voting Member One Details

Voting Member One First Name(Required)

Voting Member One Surname(Required)

Voting Member One Address 1(Required)

Voting Member One Address 2

Voting Member One Town(Required)

Voting Member One County(Required)

Voting Member One Eircode(Required)

Voting Member One Email Address(Required)

Voting Member One Phone Number(Required)

Voting Member Two Details

Voting Member Two First Name(Required)

Voting Member Two Surname(Required)

Voting Member Two Address 1(Required)

Voting Member Two Address 2

Voting Member Two Town(Required)

Voting Member Two County(Required)

Voting Member Two Eircode(Required)

Voting Member Two Email Address(Required)

Voting Member Two Phone Number(Required)

All members must adhere to the Code of Conduct. You must read the Code of Conduct before submitting the form.

Read the Code of Conduct here or click here for the Easy Read version

I have Read Code of Conduct?

Yes

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First Last

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Person with Down syndrome

Voting Member One Details

Voting Member Two Details