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Personal Details

Pledge Web Submission Pledge Web Submission NoPledge Web Submission Yes
Full Name **
Email Address ***
Phone Number **
Address Line 1 **	Address Line 2 *
City/ Town/ Village *	County * Antrim Armagh Carlow Cavan Clare Cork Derry Donegal Down Dublin Fermanagh Galway Kerry Kildare Kilkenny Laois Leitrim Limerick Longford Louth Mayo Meath Monaghan Offaly Roscommon Sligo Tipperary Waterford Westmeath Wexford Wicklow Down Tyrone
EIRCODE **

Accommodation Details

Who owns the accommodation? * Owner & Occupier Owner (Not Occupier) Tenant
What type of accommodation are you pledging? * House - Bungalow Apartment House - Semi-Detached Terrace House - Detached Hostel Hotel B&B Other
Is the accommodation vacant or will it be shared? * Vacant Shared Not Confirmed
How many available bedrooms can you offer? * 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Who can you accommodate? * Family Couple Single Males Single Females Single Adult
When is the accommodation available from? *	When is the accommodation available to? *
Do you represent an organisation Do you represent an organisation NoDo you represent an organisation Yes
Is there anything else that you would like to say about the accommodation? *

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