<p> Wicklow County Council 1916 Public Collections Day 17 th May 2016 Venue: County Buildings, Wicklow Town</p><p>PRE- REGISTRATION FORM</p><p>It is recommended that all those interested in participating in our Public Collections Event complete and return this registration form in advance. This will help us to ensure that there is sufficient time allocated to each participant on the day. Your co-operation is greatly appreciated.</p><p>YOUR CONTACT DETAILS 1. FULL NAME: </p><p>2. ADDRESS: </p><p>3. EMAIL: </p><p>4. TELEPHONE: </p><p>YOUR MATERIAL</p><p>I would like to (please tick one or both as appropriate)</p><p>Bring along material (e.g.object, document, medal, photograph, story, etc) to be copied and recorded on the day (Please provide information about your object overleaf and return with this form or bring along on the day)</p><p>Participate in an interview to describe the object or share a story.</p><p>YOUR APPOINTMENT</p><p>Appointments will be made on the hour, between 1.00 and 7.00 pm on Tuesday 17th May, if you have a preferred time please indicate so here; ______</p><p>We will try to accommodate you as best we can and a member of our team will contact you to confirm your appointment in advance. Please complete the form overleaf to describe the nature of the material that you intend to bring along to be recorded as part of the Wicklow1916 Public Collections Day.</p><p>All forms to be returned to: Wicklow 1916 Collection Day, Wicklow Heritage Office, Wicklow County Council, County Buildings, Wicklow Town Or E-mail: [email protected]</p><p>For queries please contact: Catherine Wright/ Deirdre Burns Tel: 0404 20100 Ciara O Brien Tel: 01 2866566</p><p>Submissions Form: Inspiring Ireland 1916 www.inspiring-ireland.ie For admin use only Ticket: OBJECT INFORMATION: Interviewer Name Inputted to website by (initials): Please provide information about you object/ material below. This form can be returned with your registration form or brought with you on the day. </p><p>Title: Original Owner/Creator: Date of object/document/photo: Format (i.e. paper, photo, metal, etc.): Context: (What is your relation to the person in this story, and how did you come to be in possession of the object?)</p><p>Object Description & Story:</p><p>Submissions Form: Inspiring Ireland 1916 www.inspiring-ireland.ie </p>