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Agent Associate Membership Application Form

Agent contact person

First

Last

Email address of contact person

Email

Confirm Email

Name of Agency

Phone number

Would you like to add other email addresses?

Emails to add

Please enter the necessary emails separated by commas.

Do you currently send High School students to Ireland via an Irish guardianship provider?

Is the Irish guardianship provider a current member of AGPI?

(See current members list here)

Please give the provider's name here:

Do you currently send High School students to other countries?

Which countries?

Do you operate your own High School Programme in Ireland?

Are you the director of a guardianship/high school programme company registered in Ireland?

Please give details about your company in Ireland.

Name (printed)

Date

Signature

By submitting this application, I confirm that my agency wishes to become an agent associate member of the AGPI and henceforth, we are open to working with AGPI member guardianship providers and we will strongly encourage our existing providers to act within the national legislative and policy context by becoming AGPI members and I consent to having this website store my submitted information so they can respond to my inquiry.