Membership application

1st November 2016 to 31st October 2017

Please mark chosen membership:

Membership fees 2016 / 2017      

  • Adult (including MCI): €50
  • Adult (current member of another MCI club): €20

Name­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­__________________________________________________

Address_______________________________________________

E-mail________________________________________________

Date of birth____________________________________________

Telephone___________Mobile______________________________

Emergency contact name___________________________________

Emergency contact telephone number_________________________ 

For any new members who already belong to another MI recognised club

Club name__________________________________MI no.______

Conditions of membership:

I agree to comply with the Club Constitution and any other guidelines, best practices
and codes of conduct issued by the Club Committee.

Signed:_________________

Date:___________________