VSI – General Membership Application Form

I confirm that I am blind/vision impaired, or I am completing this form on behalf of someone who is blind/vision impaired

Tick here if Completing this form on behalf of another person (Please add your details to Alternative Contact Section)

First Name

Last Name

Email – Parent/Guardian if U18

Mobile – Parent/Guardian if U18 (please input numbers only no additional characters)

Emergency Contact Name

Emergency Contact Mobile

Street

Area/Town

County

Eircode/Postcode

Gender

Date of Birth (please use format DD/MM/YYYY)

How did you hear about Vision Sports Ireland

Heard of us Other – Please Specify

Consent to receive emails from VSI

Consent to receive VSI info via other formats:

PhonePost SMS

Alternative Contact Name

Alternative Contact Relationship

Alternative Contact Phone

Alternative Contact Email

You will receive information on sports, physical activity and education opportunities available from Vision Sports Ireland and partners. If you would like additional information on our Online Exercise Classes or ICan please tick the relevant boxes below.

The “I Can” programme is a remote 6-week 1:1 health and well-being intervention exclusively for members of Vision Sports Ireland who are aged 30+ and would like support to improve their health and wellbeing

Interested in “I Can”

The “Home Exercise Series” is online or phone-in audio-described exercise classes tailored for people who are blind or vision impaired.

Interested in “Home Exercise Series”

I agree to VSI Terms & Conditions below

Read the VSI Terms and Conditions

VSI – General Membership Application Form

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