Individual Membership Application Form
Academic Year - 2017/2018
Membership will be processed when appropriate membership fee is paid using the following:

Bank Transfer
For online transfers, ILSA Bank details are as follows:

Permanent TSB, 115-116 West St., Drogheda, Co. Louth. ACCOUNT NO. 11704140
Bank Sort Code: 990622 BIC: IPBSIE2D IBAN: IE80IPBS99062211704140

If your ETB is making an Electronic Payment on your behalf, please ask the ETB for a Creditor Remittance
Advice Form and send that with your completed application form. to Catherine Flanagan, Hon. Treasurer, ILSA
at the address above..

By Post
Please send payment or evidence of payment (in favour of Irish Learning Support
Association) to:

Catherine Flanagan. Honorary Treasurer, Irish Learning Support Association, c/o Drumcondra Education
Centre, Drumcondra, Dublin 9

Email address *
Teacher Name *
Your answer
Teaching Council Number *
Your answer
Teacher Mobile Number
Your answer
Address *
Your answer
Eircode *
Your answer
County *
Your answer
Name of school employed (if none, write 'none') *
Your answer
Education Centre *
Your answer
A copy of your responses will be emailed to the address you provided.
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