Membership Application Form About YouName* First Last Are you an existing member of Diabetes Ireland?*YesNoDiabetes Ireland Membership NumberIf you are an existing member of Diabetes Ireland please enter your membership number. 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I do wish to receive the Diabetes Ireland Magazine I do not wish to receive the Diabetes Ireland Magazine Keeping in Touch*As a member with us, we would love to keep you updated on news, events, products & services, and the different ways you can support us, including financial support. We will not provide or sell your personal data to other companies for marketing purposes. We may pass your personal data to our partners in order to process your orders and fulfill your requests. **Please note; if you have opted in to receiving the Diabetes Ireland Magazine, you must opt in to 'By Post' Please tick the ways you are happy to be contacted: By email By post By phone By text message I do not wish to receive communications from Diabetes Ireland PLEASE NOTEIf you have chosen to receive the Diabetes Ireland Magazine you must opt into receiving communication 'By Post'. The magazine is currently not available electronically. Your MembershipMembership*Please choose the membership option that suits you best.Membership & Monthly Draw (€60) (€1,200 Cash Prize Per Month)Family / Sweetpea (€45)Individual (€40)Senior / Student (€30)Health Professional (€45)DonationIf you wish to make an additional donation please select the amount you wish to donate. Every member and donation makes a difference, so please give what you can. Thank you.Donation Amount€10€20€50€100Total € 0.00 PaymentIn an effort to reduce costs Diabetes Ireland is encouraging members to pay by direct debit. For Direct Debit, click on the option and download the mandate form and return the signed copy to Diabetes Ireland. Please select the payment method below that suits you best. Payment methodPlease select your payment method. Available options: Credit/Debit Card or Bank Direct DebitPayment by Credit/Debit cardDirect Debit *Please note that if you have opted into receiving the Diabetes Ireland magazine you must select correspondence by post.