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Application for IFUW Independent Membership

Attention

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

Personal Information

Title
 Miss      Mrs      Ms      Dr
Name in full
Name under which degree obtained,
if different
Street
 
City
State
Postal code
Country
Telephone
Fax
E-mail
Nationality
Year of birth
Profession
Present Occupation
Languages spoken
Languages written

Education

Degrees(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


Other information

How did you learn about IFUW?

Why do you wish 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 which payment method you will use to pay for 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

 

Submit your form

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.