NAME OF SCHOOL/INSTITUTION

ADDRESS ___________________________________________________

___________________________________________________

___________________________________________________

Telephone: _________________________

Email address __________________________________________________

Principal's Name __________________________________________________

Contact Person __________________________________________________

How did you hear of the Association? ______________________________________

Interest in joining the Association_________________________________________

_________________________________________

I agree/ do not agree to have my institution name, address and telephone number being included on a membership list circulated to members.

Signed __________________________________________

Please return with £10 subscription to

Irish Association for Gifted Children (IAGC)
An Óige Thréitheach (AOT)
Carmichael House
4 North Brunswick Street
Dublin 7
Contact Telephone: (01) 873 5702