How to become a member

In order to be eligible for membership of COPD Support Ireland you must first have received a diagnosis of COPD by a medical professional. The medical conditions which fall under the umbrella term of COPD are: emphysema, chronic bronchitis & some asthmas.

To join COPD Support Ireland, you can do so by filling in our online membership application form

Once the completed form has been received a member of our team will be in contact with you to advise you of the benefits of membership, your local support group and the activities which are run by COPDSI.

Online Membership Application Form

Note: Fields with a corresponding red Asterisk are required

Salutation
First Name *
Last Name *
Email **Must be a valid email in the format example@example.xxx
Phone *
Street *
City *
EirCode
Country
State/Province
Type Of Member: *
Reason for joining:
Membership Benefits: *
Preferred Contact Method: *

By ticking this box I am agreeing to become a member of COPD Support Ireland and to COPD Support Ireland holding my personal data on file during my period of membership for administrative purposes.:

Date of Form (DD/MM/YYYY):
Emergency Contact First Name:
Emergency Contact Last Name:
Emergency Contact Phone:
Emergency Contact Email:*Must be a valid email in the format example@example.xxx
Emergency Contact Street:
Emergency Contact City:
Emergency Contact EirCode:
Emergency Contact Country:
Emergency Contact County:
Relationship to member:

COPD Support Ireland

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