EirGrid Membership Form

Prefer paper? Download the printable form, sign it, and send it back to us. Download form (Word)

1 · Personal details

Title

Surname *

Forename(s) *

Date of birth

Home address

2 · Employment details

Work e-mail *

Desk phone

Mobile

Normal work address

Category

Grade / band

Qualification

3 · Application & payroll deduction

Staff number

Full name (for signature) *

Submitting this form authorises ESPA Unite to deduct the standard 0.5% gross-salary contribution from my EirGrid payroll, on the same terms set out in the printable form above. This typed name stands in for a signature online — return the signed paper form if your payroll office requires a wet signature.

We'll email your details straight to ESPA — no account needed.

Form owner: this submits to submit-eirgrid.php, which fills your EirGrid form image with the entered details and emails it to the address set in that file's RECIPIENT_EMAIL constant. Needs PHP hosting with the GD extension (standard on most shared hosting) — see README.txt for setup.