RENEWAL FORM
	IFUW INDEPENDENT MEMBERSHIP

If you are already an independent member, or have been one within the last five years, you need only fill in this form.

Miss Mrs Ms Dr

FULL NAME:
ADDRESS:
STREET
CITY
STATE		POSTAL CODE
COUNTRY
TELEPHONE:	FAX:
E-MAIL:

PLEASE INDICATE HOW YOU PLAN TO PAY YOUR IFUW MEMBERSHIP RENEWAL FEE:
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

Signed:

Date:

If there will be a delay in making your payment, please let us know.

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.