Are you an existing member of Diabetes Ireland?* Yes No If yes, please complete the form below. If you have not joined our community yet, please complete the form following THIS LINK and join Diabetes Ireland Community Network Programmes! First Name* Last Name* Membership number Email address* Street* City* County* Eircode* GeoCode --None-- Abroad All Carlow Cavan Clare Cork Donegal Dublin County Dublin North Dublin South Galway Kerry Kildare Kilkenny Laois Leitrim Limerick Longford Louth Mayo Meath Monaghan Offaly Roscommon Sligo Tipperary North Tipperary South Ulster United Kindom Unknown Waterford Westmeath Wexford Wicklow Mobile Membership status Concessionary Senior (€30) Concessionary Student (€30) Family (€45) Individual (€40) Healthcare Professional (€60) Member and Draw Concessionary Senior (€60) Member and Draw Concessionary Student (€60) Member and Draw Family (€60) Member and Draw Individual (€60) If you are a Healthcare Professional please complete the information below If you choose Other as Professional Status please fill in your Occupation in the box provided. Professional status I'm not a healthcare professional Clinical Nurse Specialist Clinical Nurse Specialist Diabetes Counsellor Dietitian - Adult Diabetes Dietitian - Paeds Diabetes Dietitian - Pregnancy Midwife Medic - Adult Diabetes Medic - Consultant Medic - General Medic - GP Medic - Non Consultant Medic - Paeds Diabetes Nurse - Adult Diabetes Nurse - Community Nurse Nurse - General Nurse - Paeds Diabetes Nurse - Practice Nurse Nurse - Pregnancy Nurse - Residents Home Pharmacist Podiatrist - Community Podiatrist - Hospital Psychologist Public Health Non Nursing Researcher Other Occupation By submitting this form you agree with the Terms and Conditions and Privacy Policy.