Join the Platform - National Platform of Self Advocates

Membership Form

On this page you can learn more about becoming a member of the Platform. We want you to join us so that we can fight for the rights of people with disabilities. We believe that working as a group is better than working on our own.

By joining us we will ‘Stand Up and Speak Out’ as one voice.

Click the National Platform Membership Form to print the form and fill it out.

You can fill out the form on this page instead and we will get it by email.

The Benefits of becoming a member.

You can come to the meetings
You can come to our Conferences for a reduced fee
You can vote for the new Steering Committee
You can be elected to the new Steering Committee
You can be a Platform Representative for your County

A. Personal Details

Your Name:

Address:

Phone:

Your Email:

B. Please answer this section if you want to use a support contact person:

Support Name:

Support Address:

Support Phone:

Support Email:

C. Are you a member of an Advocacy Group? Please mark Yes or No

YesNo

If you answered Yes what is the name of the Advocacy Group?

D. Are you supported by an organisation? Please mark Yes or No

YesNo

If you answered Yes what is the name of the Advocacy Group?

E. How are you paying your membership fee?

ChequeCashLodge to Platform Account

Your Message

Annual Membership of the National Platform of Self Advocates is €10
These are the National Platform’s Bank details:

Bank name and address: Bank of Ireland, O’Connell Street, Dublin
IBAN: IBAN IE84 BOFI 9000 3375 6903 68
Sort Code: 90-00-93
BIC: BOFIIE2D

I understand that I am becoming a member of the National Platform of Self Advocates

Check here to indicate agreement.