Membership Form

Membership runs from 1st January until 31st December each year regardless of joining date. Shine is an adult organisation. We do not respond to the needs of children. All full members have the right to vote at general meetings. Shine reserves the right to refuse membership without disclosing specific reasons.

Fields marked with a red asterisk * must be completed.

If you are a human and are seeing this field, please leave it blank.

Membership Type

Select A Membership Type: *

Individual Membership (€10)
Family Membership (€20)
Student/Volunteer Membership (€5)

Membership Details

First Name *

Last Name *

Address 1 *

Address 2 *

County *

Post Code

Email *

Date of Birth (DD/MM/YYYY) *

I am: *

Male
Female

Main Phone *

Home Phone

Work Phone

Payment Details

Total

Card Number The (typically) 16 digits on the front of your credit/debit card.

CVC The 3 digit (back) or 4 digit (front) value on your card.

Name on the card The name printed on the front of your credit/debit card.

Expiration month (MM) The month your credit/debit card expires, typically on the front of the card.

Expiration year (YYYY) The year your credit/debit card expires, typically on the front of the card.

I understand that the information I provide will used for membership purposes only and will not be shared with a third party without my consent. *

There are no voting rights with this membership but you will have access to all of our support groups and open source information.