IACCN

Membership

Irish Association of Critical Care Nurses Membership Application / Renewal Form

Please fill out the form below and click on 'Submit by Email' or alternatively print out a copy and mail it to us.

Name:
Job Title/Grade:
Department/Specialty:
Work Address:
Postal address for correspondence (if different from above):
Tel: Work
Tel: Home / Mobile
Email address for correspondence (as written):	*
Please clarify if new member / renewal:
Membership number (if applicable):
Please state if you are prepared to be a contact person for your department	YesNo

Alternatively you can arrange payment by standing order, contact IACCN for details.Annual membership costs € 40.00 and is renewable from September/Annually. Cheque/postal order payable to the IACCN, and return the completed application form to:
Siobhan O’Keeffe,
Intensive Care Unit,
Mater Misericordiae University Hospital,
Eccles Street, Dublin 7
Email: info@iaccn.ie