Contact Information

Title... Please select a value from the list	* First Name Please enter your first name	* Family Name Please enter your family name
* Email Address Please enter your email address, email addresses must match exactly * Confirm Email Address Please confirm your email address, email addresses must match exactly
Select your Country * Select Country... Please select a country
Select your Telephone Country Code Please select a country code	Telephone Number Please enter a phone number using numbers only, must be between 5 and 12 digits
AerClub Tier Please select a value from the list	* AerClub Membership Number Please Enter your 16 Digit AerClub Membership Number

Flight Information (if applicable)

To add more than one flight, simply click the '+' sign:

Booking Reference Must start with a 2, contain letters and numbers, 6 characters long

Flight Number Flight Number must be 3 or 4 digits; without airline code i.e. EI

Flight Date Please enter a valid date (dd-MMM-yyyy)

Flight Number Flight Number must be 3 or 4 digits; without airline code i.e. EI

Flight Date Please enter a valid date (dd-MMM-yyyy)

Flight Number Flight Number must be 3 or 4 digits; without airline code i.e. EI

Flight Date Please enter a valid date (dd-MMM-yyyy)

Flight Number Flight Number must be 3 or 4 digits; without airline code i.e. EI

Flight Date Please enter a valid date (dd-MMM-yyyy)

Type of Disability Assistance needed

To add more than one request, simply click the '+' sign:

Select a Disability Assistance Request * Select Assistance Needed Please select a value from the list

Select a Specific Disability Request * Please select a value from the list

Comments

Please provide any additional information to assist us with your request,
i.e. include device make and model; dimensions and weight; battery type and wattage

Characters Remaining :1000
Please upload all the relevant documentation with your request including all medical device specifications.
File To Upload:
Maximum size limit 5 MB
We are unable to accept Word documents. Please consider sending PDF files instead.

In order to process this Special Assistance Request, Aer Lingus requires you to provide us with your consent as follows:

I consent to:

Aer Lingus processing my personal data in relation to this Special Assistant Request, including Contact Information, Flight Information, and details of my Disability Requirements.
Aer Lingus supplying my personal data including Contact Information, Flight Information, and details of my Disability requirements to relevant third-party special assistance service providers.

I understand that processing of my personal data is necessary for the purposes of providing Special Assistance per this request.

All required fields must be completed before you will be able to submit the form.