Migraine :: Membership Form

Online Payment Using Secure Server

Membership

To become a new member or to renew your membership please select a membership type and complete the details below. You can also make a donation at the same time.

Make A Donation

To make a donation please enter an amount in the donation field below, complete the personal details and then submit.

All fields marked with an asterisk (*) must be completed

Make a Donation
Donation (eg 20 for €20):

Become a member/Renew Membership
Please choose one of the following:
New Member:	Renewal of Membership:

Membership Type:
Select Membership Type

Tick here if you would like to receive our email newsletter 'Migra_zine'. Please clearly write your email in the Personal Details section below.	Tick here if you would like to find out about volunteering opportunities within the MAI.

The Migraine Association of Ireland (MAI) requires this information to process your application, post membership-related material to you, and to keep you informed of events, issues, and opportunities relating to migraine or to the aims of the MAI. Occasionally, the MAI may determine that products/ services of appointed agents or third parties might be beneficial to our members and, under strict non-disclosure agreements, some of your information may be given to such parties, or may be used by MAI directly to inform you of the product or service. If you do not wish to receive such communication, please tick the box provided.

Personal Details:
Title:
First Name:(*)
Surname:(*)
Address:(*)



Tel Number:
Mobile:
Email: (*)
Date of Birth: (dd-mm-yyyy format)
Occupation:
Refund Policy: Please note that you have a right to a full refund of the amount you have paid within seven days of making payment. If you would like a refund please email the Migraine Association, including the transaction id you received when your payment was confirmed by email and the amount.

This will take you to our secure server where you can enter payment details.