Cleft lip & palate association of ireland

Download 11.03 Kb.
Date conversion01.02.2017
Size11.03 Kb.


Mailing List Subscription Form

I am a new subscriber

Existing Subscriber change of details

Surname: ___________________________

(More than one family member may subscribe)

I wish to receive the newsletter and other notifications via:

Letter post



Please cancel my subscription

Title/Forename: _____ _______________________


Family member: _____ _______________________

Telephone No.: ____________________________

E-mail: _______________________________

Select the appropriate category:

I am a parent

I was born with a cleft
I am a medical professional
None of the above

Second family member:

I am a parent
I was born with a cleft
None of the above

Date: _____________________________

Send to: Cleft Lip & Palate Association of Ireland,

c/o 36 Woodlands Avenue, Dun Laoghaire, Co. Dublin, Ireland

Privacy Statement
The Cleft Lip and Palate Association of Ireland (CLAPAI) is committed to maintaining the privacy of those who furnish personal details to the Association. Personal information where provided is only used to improve the services CLAPAI offers to you, or to contact you regarding matters of the Association. Please do not furnish any information to the Association which you do not want held on record. The individual retains the right to opt-out of receiving any communications. Personal information furnished to CLAPAI is held in strict confidence and is not made available to third parties.

The Cleft Lip & Palate Association of Ireland, registered charity, is a limited liability company, No. 131497.

URL: | e-mail:

The database is protected by copyright © 2016
send message

    Main page