Irish Heart Foundation : Register

Joining Team Leixlip Team

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?

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Address Line 1 *

Address Line 2

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Eircode *

County

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

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