Irish Road Victims Association

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Thank you for your interest. So that we can assist you with your enquiry, please complete and submit the form below. Please note that by completing and submitting this form, you are giving us your consent to securely pass on your information to Irish Road Victims Association, and a free membership account will be created for you on our website.

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Phone number We ask for your telephone phone number as a secondary form of contact. It is not mandatory, but may prove to be helpful as part of your application. Your phone number will only be used in relation to this application and will not be passed on to third parties.

Why do you want to participate?

Fundraising target: €1400

Although €1400 is our preferred minimum fundraising target it is not the sole criteria for selection. We will consider a range of factors when allocating our places, including personal reasons for taking part and the amount you can successfully fundraise. Successful applicants will need to arrange their own travel and accommodation.

How much do you pledge to fundraise?

How will you meet your fundraising goal?

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