Irish Heart Foundation : Register

Joining Team Chicken Dippers

First Name *

Last Name *

Email Address *

Password*

Mobile *

Are you happy to hear about other Irish Heart Foundation work and activities by phone and email?

Yes No

Address Line 1 *

Address Line 2

Town/Locality *

Eircode *

County

Country *

By submitting your information you are agreeing to us using your data to process your registration and fundraising for the 12 Dips in December

I agree to the above Terms & Conditions & privacy policy *