Wound Management Assocition of Ireland

W M A I

Application Form

Please complete and print this page, and send it along with a cheque for €30/£20 made payable to WMAI, to the following address:

If you wish to pay by PayPal using credit/debit card please Click Here.

Please return to:-

Niamh Mc Lain
46 Sweetmans Avenue
Blackrock
Co. Dublin

Title

First Name

Surname

Address

Phone Number

Mobile Number

Fax Number

Occupation

Area of Interest

PayPal Ref (if applicable)

Which region do you wish to join ?
	Northern Western Midlands Dublin / Wicklow Southern