{"id":8993,"date":"2017-12-11T09:46:52","date_gmt":"2017-12-11T09:46:52","guid":{"rendered":"http:\/\/localhost:8888\/wordpress-test\/?page_id=8993"},"modified":"2018-01-02T11:17:45","modified_gmt":"2018-01-02T11:17:45","slug":"apply-for-membership","status":"publish","type":"page","link":"https:\/\/brokersireland.ie\/benefits-of-membership\/apply-for-membership\/","title":{"rendered":"Apply for Membership"},"content":{"rendered":"<div style=\"width: 100%;\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f9188-o1\" lang=\"en-GB\" dir=\"ltr\" data-wpcf7-id=\"9188\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/wp-json\/wp\/v2\/pages\/8993#wpcf7-f9188-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"9188\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.1\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_GB\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f9188-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<p><label> Full Name (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"full-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"full-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> Registered Company Name (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"reg-comp-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"reg-comp-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> Company Address (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"com-address\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"com-address\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label> Landline Number (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tel-land\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"tel-land\" \/><\/span><\/label>\n<\/p>\n<p><label> Mobile Number (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tel-mob\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"tel-mob\" \/><\/span><\/label>\n<\/p>\n<p><label> Main Email (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"main-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"main-email\" \/><\/span> <\/label>\n<\/p>\n<p><label> Website<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"url-website\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-url wpcf7-text wpcf7-validates-as-url\" aria-invalid=\"false\" value=\"\" type=\"url\" name=\"url-website\" \/><\/span><\/label>\n<\/p>\n<p><label> Other Email Addresses (employees\/staff)<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"other-email-1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"other-email-1\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"other-email-2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"other-email-2\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"other-email-3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"other-email-3\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"other-email-4\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"other-email-4\" \/><\/span>\n<\/p>\n<p>Tick the relevant services you provide:\n<\/p>\n<p><strong><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-general\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"checkbox-general[]\" value=\"General Insurance\" \/><span class=\"wpcf7-list-item-label\">General Insurance<\/span><\/span><\/span><\/span><\/strong><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-gen-opt\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-gen-opt[]\" value=\"Motor\" \/><span class=\"wpcf7-list-item-label\">Motor<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-gen-opt[]\" value=\"Household\" \/><span class=\"wpcf7-list-item-label\">Household<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-gen-opt[]\" value=\"Travel\" \/><span class=\"wpcf7-list-item-label\">Travel<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-gen-opt[]\" value=\"Health\" \/><span class=\"wpcf7-list-item-label\">Health<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-gen-opt[]\" value=\"Legal Expenses\" \/><span class=\"wpcf7-list-item-label\">Legal Expenses<\/span><\/span><\/span><\/span>\n<\/p>\n<p><strong><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-commercial\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"checkbox-commercial[]\" value=\"Commercial Insurance\" \/><span class=\"wpcf7-list-item-label\">Commercial Insurance<\/span><\/span><\/span><\/span><\/strong>\n<\/p>\n<p><strong><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-life\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"checkbox-life[]\" value=\"Life\" \/><span class=\"wpcf7-list-item-label\">Life<\/span><\/span><\/span><\/span><\/strong><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-life-opt\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-life-opt[]\" value=\"Pensions\" \/><span class=\"wpcf7-list-item-label\">Pensions<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-life-opt[]\" value=\"Investments\" \/><span class=\"wpcf7-list-item-label\">Investments<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-life-opt[]\" value=\"Protection\" \/><span class=\"wpcf7-list-item-label\">Protection<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-life-opt[]\" value=\"Mortgages\" \/><span class=\"wpcf7-list-item-label\">Mortgages<\/span><\/span><\/span><\/span>\n<\/p>\n<p><strong>Tick your authorisation status:<\/strong><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-auth\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-auth[]\" value=\"Authorized\" \/><span class=\"wpcf7-list-item-label\">Authorized<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-auth[]\" value=\"Pending\" \/><span class=\"wpcf7-list-item-label\">Pending<\/span><\/span><\/span><\/span>\n<\/p>\n<p><strong>Optional: Please tick Authorisations<\/strong><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-auth-opt\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-auth-opt[]\" value=\"IDR\" \/><span class=\"wpcf7-list-item-label\">IDR<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-auth-opt[]\" value=\"IIA\" \/><span class=\"wpcf7-list-item-label\">IIA<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-auth-opt[]\" value=\"CCA\" \/><span class=\"wpcf7-list-item-label\">CCA<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-auth-opt[]\" value=\"CMCAR\" \/><span class=\"wpcf7-list-item-label\">CMCAR<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-auth-opt[]\" value=\"MIFID\" \/><span class=\"wpcf7-list-item-label\">MIFID<\/span><\/span><\/span><\/span>\n<\/p>\n<p><strong>Payment Option:<\/strong> (Please tick prefferred payment option)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-pay-opt\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-pay-opt[]\" value=\"Yearly Fee\" \/><span class=\"wpcf7-list-item-label\">Yearly Fee<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-pay-opt[]\" value=\"DD\" \/><span class=\"wpcf7-list-item-label\">DD<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-pay-opt[]\" value=\"EFT\" \/><span class=\"wpcf7-list-item-label\">EFT<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-pay-opt[]\" value=\"Credit Card\" \/><span class=\"wpcf7-list-item-label\">Credit Card<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-pay-opt[]\" value=\"Monthly (\u20ac125)\" \/><span class=\"wpcf7-list-item-label\">Monthly (\u20ac125)<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-pay-opt[]\" value=\"1st\" \/><span class=\"wpcf7-list-item-label\">1st<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-pay-opt[]\" value=\"14th\" \/><span class=\"wpcf7-list-item-label\">14th<\/span><\/span><\/span><\/span>\n<\/p>\n<p><strong>Additional Information \/ Requests<\/strong><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-requests\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"textarea-requests\"><\/textarea><\/span>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":8788,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"template-become.php","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-8993","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.8 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Apply for Membership | Brokers Ireland<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/brokersireland.ie\/benefits-of-membership\/apply-for-membership\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Apply for Membership | Brokers Ireland\" \/>\n<meta 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