Registering with the IMNDA - IMNDA %

Registering with the IMNDA

Please note this form is for somebody with MND only. If you are registering on a person’s behalf (with their consent) please call the office on 01 670 5942 . Thank you.

  • Your Details

  • DD slash MM slash YYYY

  • Contact Preferences

  • Ongoing Contact

    We will only contact you when relevant. Please let us know how you wish to receive contact from us.

  • Next of Kin/Contact Person Details

  • Does next of Kin wish to receive contact from the IMNDA?

  • Healthcare Team

  • DD slash MM slash YYYY
  • This field is for validation purposes and should be left unchanged.
Irish Motor Neurone Disease Association
Unit 3, Ground Floor,
Marshalsea Court,
22/23 Merchant’s Quay,
Dublin 8, D08 N8VC.
Tel: 01 670 5942. Freefone: 1800 403 403.
Charity Registration Number: 20021009 CHY: 8510
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