Nomination to National and / Regional Statutory Committees.

Please take the time with your line manager to review the DFI Rep Protocol before completing this form. The survey will not take too long to complete and if you have any queries contact Cathy McGrath - cathymcgrath@disability-federation.ie / 086 384 7440.

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* 1. Your name

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* 2. Your email address:

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* 3. Your mobile number:

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* 4. What are you applying for today? Please pick one of the following:

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