Membership application/renewal

Please return this form with the requested details with your subscription to Clíona Ní Bhréartúin, 12 Beechview, Edmondstown Road, Dublin 16. Any queries, please email: cnibh@eircom.net.

Surname: ______________________________________ Forename: ____________________________

Postal Address: _______________________________________________________________________

____________________________________________________________________________________

Phone no. (home): ___________________________ Phone no. (work): ___________________________

Phone no. (mobile): __________________________ Email: _____________________________________

For insurance purposes, are you a member of the Mountaineering Council of Ireland? Yes __ No __

If so, are you an If you are in a club, _____________________________ individual member

please specify or a club member?_______________________ which one? __________________________

Can you bring any relevant experience to Mountain __________________________________________

Meitheal (e.g. engineer, forester, farmer, previous voluntary trail maintenance experience, etc.) __________________________________________

I wish to apply for/renew my membership of Mountain Meitheal and enclose my subscription of €20 (cash or cheque) and agree to support the aims and objectives of the club.

Signed: _______________________________________________ Date: _______________________