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1. Organisation Details
Organisation Name
Tell us about your organisation and it's aims:
Select the Cause that most closely represents the work of your organisation:
--None--
Addictions and Recovery
Animals
Arts, Culture and Media
Carers
Children
Community Centre
Community Development
Crime/Safety
Education/Literacy
Emergency and Ambulance Services
Environment and Conservation
Families/Parenting
Health/Hospitals/Hospices
Heritage/Museums/Galleries
Homelessness/ Housing
Human and Civil Rights/Equality
Intellectual/Learning Disabilities
Law/Legal Support/Justice
LGBT
Mens Groups
Mental Health
Minority Groups
Older People/Active Retired
Overseas Aid/Development
Physical Disability
Politics
Prisoners/Offenders/Ex-offenders
Refugees/Asylum Seekers
Religion/Faith based
Residents Association
Sensory Impairment
Social Inclusion
Sports/Outdoor activities
Unemployment
Volunteering and Active Citizenship
Womens Groups
Youth
Select the Pilar that most closely represents the activities of your organisation:
--None--
Community
Environment
Social Inclusion
Groups Structure:
--None--
Affiliated
Association
Charity
Committee
Co-operative
Limited Company
Other
Set of Rules
Trust
If Other please describe:
The Geographical area you operate in:
--None--
Adamstown
Ballyboden
Ballycragh
Ballycullen
Ballyroan
Brittas
Brookfield
Citywest
Clondalkin-wide
Countywide
Fettercairn
Firhouse
Greenhills/Walksinstown
Jobstown
Killinarden
Kilnamanagh
Kingswood
Knocklyon
Lucan
Neilstown
Newcastle
North Clondalkin
Old Bawn
Palmerstown
Parkwest
Perrystown
Rathcoole
Rathfarnham
Ronanstown
Saggart
South West Clondalkin
Tallaght-wide
Templeogue
Terenure
Tymon North
Whitechurch
Electoral Area of your main base:
--None--
Clondalkin
Lucan
Rathfarnham
Tallaght Central
Tallaght South
Templeogue-Terenure
Number of people involved in your organisation:
Year Established:
--None--
Before 1971
Between 1971 and 1980
Between 1981 and 1990
Between 1991 and 2000
Between 2000 and 2010
After 2010
Website
Facebook Page:
Continue to Step 2
2. Main Address For Correspondence
Street
City
County/Postcode
Continue to Step 3
3. Main Contact Details
First Name
Last Name
Email
Mobile
Phone
Are you the Main Contact for this Organisation?
Will you be the representative or the alternative for your organisation in relation to the PPN?:
--None--
Representative
Alternative
Continue to Step 4
4. Alternative Details
Alternate First Name:
Alternate Surname:
Alternate Mobile:
Alternate Email:
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