HADD IRELAND
MEMBERSHIP FORM
New Member ___ Membership Renewal ___ (Please tick as appropriate)
Name ______
Address ______
______
Tel. ______Email: ______
(Please use block capitals)
Category
Parent/Carer €30 ___ Adult €30 ___ Professional €40 ___
Receipt to follow with further information
If you are a parent, please tell us about your child. If you are an adult member, please tell us about yourself.
*D.O.B. ______Boy ___ Girl ___ Young Adult 18 – 25 ___ Adult 25 and over____.
Age when diagnosed ___ On Medication Yes ___ No___ What Medication ______
What services, if any, are you receiving?______
Any other relevant information? ______
For Professionals: *Your Profession ______
Do you work with children Yes ___ NO ___ Do you work with Adults Yes___ No ___
Signed: ______Date: ______
Return this form, together with cheque or postal order, made payable to the HADD Ireland, to: Membership Secretary, HADD Ireland, Carmichael Centre, North Brunswick St. Dublin 7
PLEASE READ THE REVERSE SIDE OF THIS MEMBERSHIP FORM
HADD IRELAND AIMS AND OBJECTIVES
Awareness:
To raise awareness of Attention Deficit Hyperactivity Disorder (ADHD),
related disorders, and comorbid conditions.
Information:
To provide information on ADHD to people with ADHD,
carers of people with ADHD, health professionals,
and other interested parties.
Support:
To provide a support network for carers of people
with ADHD and for people with ADHD.
PLEASE NOTE: Services of HADD Ireland are available only to members. The Association is a voluntary body and relies totally on member’s subscriptions, donations and fundraising activities in order to enable the association to carry out its aims. As you can imagine therefore, we are always short of funds and would welcome any help you can give.
The membership subscription is as detailed overleaf. If you feel able to give a little more it would be much appreciated.
*If you would like to make a donation to the association we would very much welcome your contribution. All corporate donations are given a listing on our website.
Membership subscription €______
Donation (optional) €______
Total payment €______
Company or business name making the donation: ______
Email: website: www.hadd.ie
Registered Charity: CHY 13614