COMPLETE THIS FORM TO JOIN THE GM-FREE IRELAND CAMPAIGN

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Completing this form gives us your permision to list your name and/or the name of your organisation as an official supporter of the GM-free Ireland campaign on this web site and promotional materials. We require your email address and contact details to verify your identity, but we will not share this information with any third parties.

You must fill out all fields for this form to work. (Enter an "x" if a field is not applicable).

First name:

Organisation (if any)

Family name:

Position:

Street address:

Town / village:

county: Antrim Armagh Carlow Cavan Clare Cork Derry Donegal Down Dublin Fermanagh Galway Kerry Kildare Kilkenny Laois Leitrim Limerick Longford Louth Mayo Meath Monaghan Offaly Roscommon Sligo Tipperary Tyrone Waterford Westmeath Wexford Wicklow

country: Irish republic N. Ireland other EU outside EU

Phone:

prefix:    tel: 

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Please click the submit button once to send your response directly to our database. If you are unable to submit the form electronically, you may print your completed form and fax it to us on (0404) 43 887, or mail it to us at this address. For enquiries email mail@gmfreeireland.org