Membership Registration Form 2023/24 Name of Coordinator(Required) Currently a member?(Required) Yes No School / Centre(Required) School / Centre Address(Required) Street Address Address Line 2 City County Eircode School / Centre's Telephone Number(Required)Email(Required) Phone / MobileContacts of other LCA coordinators & teachers in school / centre (if applicable)The membership fee is €40.00Membership Price: Payment Type Pay Now Online Pay via Bank Transfer/Cheque PAYMENT INSTRUCTIONS Our bank details are as follows: Ensure to add your School Name/Coordinator name to the description of the bank payment. Or email us with a copy of the payment IBAN IE34 BOFI 9002 8783 3809 33 BIC: BOFIIE2D The membership fee is €40.00 Please make cheque payable to: Leaving Certificate Applied National Association and forward to Ms. Avril Harris, LCANA Membership Secretary, 9 Ashwood Close, Clondalkin, Dublin 22, D22EH74 Maureen Casey (Hon Treasure) mcaseylcana@gmail.com & mobile 087 2309897 Credit CardCard Details Cardholder Name
