IWA Membership Form

Name
This field is for validation purposes and should be left unchanged.
Membership is open to anyone with a physical disability – you do not need to be a wheelchair user
How would you like to complete your application?*
- Complete online
- Send a form by post

Name*
First Last
Telephone no*
Enter your landline telehphone number. If you do not have a landline, enter a mobile or other contact number.
Email*

Enter your email address. This field is required for online applications
Mobile no*
Enter your mobile to receive IWA sms updates
Postal Address*
Street Address Address Line 2 City Country
Eircode
Postal County*
Contact Phone
Contact Email
Data processing consent*
I understand that by ticking this box, I consent to the data I have entered into this form to be processed in accordance with Irish Wheelchair Association’s Privacy Policy and Terms of Service.

Privacy Overview