One In 1000 Form Test | Cystic Fibrosis

Contact Information

First Name*

Last Name*

Address Line 1*

Address Line 2*

Town/City*

County (IRL/NI)*

Eircode*

Email*

Phone*

Mobile Phone *

Further Contact (Optional)

For further information please see our privacy policy

We would love to keep you updated about our work and let you know how you can continue to help improving lives for people with cystic fibrosis in Ireland. Please tick the boxes to confirm we can contact you by:

E-mail

Phone

SMS

Registration Information

Individual Registration

Team Registration

T-shirts*

Team Registration Only

Please list the names and t-shirt size for all team members. Indicate if any of the team are a PWCF.

Participant Information

Help us to continue the success of the campaign by answering the following three questions

What is your connection to Cystic Fibrosis?

Have you taken part in the One in 1,000 Campaign before?

Where did you hear about the CFI One in 1,000 Campaign?

Please note cross infection guidelines apply to this event. More information available here www.cfireland.ie/about-cf/cross-infection