I-AIMH Membership

Type of Membership*

New MemberRenewal of Membership

Name*

First NameLast Name

Address (Please state county of employment/ residence only)*

Professional/ Practitioner Role*

Are you a student?*

YesNo

Email*

example@example.com

Date of Renewal*

Date

I-AIMH needs your consent to send future communications

I-AIMH is always committed to keeping your data safe, secure and in line with General Data Protection Regulation (GDPR).

Please read the I-AIMH privacy policy (see website www.iaimh.ie) and tick the box indicating that you consent for us to hold your personal details and to use them to contact you while you are a member of I-AIMH.

I consent for I-AIMH to hold my details so they can contact me while I am a member of I-AIMH*

Yes

Calculation

Would you be willing to join a sub- group for specific time limited projects e.g Fund raising, PR, Training, Membership Inclusion?*

YesNo

Please state area of interest to you in the space provided*

Do you consent to us contacting you in relation to this?*

YesNo

Total Amount*

EUR

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration