EmailMeForm
Membership Application for Charity Retail Ireland
CHARITY:
*
Charity name
Registered address:
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Tel no:
*
Include area code e.g 021 046 01
Email
*
Web Site
CHARITY REG NO:
Registered with the Charities Regulatory Authority
*
CHY NO:
Registered with the Revenue Commissioners
*
COMPANY REG NO:
Registered with the Companies Registration Office
*
MAIN CONTACT PERSON:
*
Position:
*
Address:
Complete only if different from the registered address of the charity
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Contact tel no:
*
Include area code e.g 021 046 01
Mobile no:
NUMBER OF SHOPS
*
Name of shops
MEMBERSHIP FEES
The scale of fees is agreed by the membership and the amount for each charity is a sliding scale depending on the number of shops it operates.
*
1 shop €180
2-5 shops €150 per shop
6-10 shops €130 per shop
11-24 shops €120 per shop
25+ 99 shops €2,950 flat rate
99+ shops €3,250 flat rate
Please tick one box.
Required
*
I agree, on behalf of my charity, to pay the membership fee which falls due in January each year
Date
*
MM
/
DD
/
YYYY
Powered by
EMF
HTML Contact Form
Report Abuse