APPLICATION FOR IFUW INDEPENDENT MEMBERSHIP

Before completing this form, please check to see if your degree, diploma, certificate or other qualification meets IFUW's eligibility requirements.

Miss Mrs Ms Dr

NAME IN FULL:

NAME UNDER WHICH DEGREE OBTAINED, IF DIFFERENT:

ADDRESS:

STREET
CITY
STATE		POSTAL CODE
COUNTRY
TELEPHONE:	FAX:
E-MAIL:
NATIONALITY:	YEAR OF BIRTH:

PROFESSION:

PRESENT OCCUPATION:

DEGREE(S) HELD:

University or Institution/Location (Eg: Cambridge University, Cambridge, England	Years attended 1974-1979	Degree awarded PhD in Economics	Year Awarded 1979)

SPECIAL FIELD(S) OF STUDY:

LANGUAGES SPOKEN:

LANGUAGES WRITTEN:

HOW DID YOU LEARN ABOUT IFUW?

WHY DO YOU WANT TO BECOME A MEMBER?

HAVE YOU EVER BEEN A MEMBER OF ONE OF IFUW'S NATIONAL FEDERATIONS OR ASSOCIATIONS?
Yes No

IF YES, WHICH ONE:

PLEASE INDICATE HOW YOU PLAN TO PAY YOUR IFUW MEMBERSHIP FEES:
Note: Instructions on how to pay your membership fee will be provided once you submit this form.

	Secure online credit card payment via Paypal
	Bank transfer

Declaration:
I declare that I hold the degree(s) stated.
I subscribe to the purposes of IFUW as set out in the leaflet and will pay the annual membership dues.

Signed:

Date:

 

Permission for Name and E-mail Address to be
Included in the IFUW E-mail Network
and to be shared with other IFUW Members

1. Are you willing for your e-mail address to be included in IFUW's International Member Network?
   Yes No
2. Are you interested in having contact with other interested university women in your own country?
   Yes No
3. Are you interested in having contacts with IFUW members from other countries?
   Yes No
   
   

Click the "Send" button below ONCE to submit your form
to IFUW and to proceed to our payment page.

If you wish to keep a copy of this page for your records,
please print it now before clicking "Send".

If you have problems sending the application form, you may print a copy and fax it to IFUW Headquarters - Fax: (+41 22) 738 04 40.