Application Form

Application for GWI Independent Membership

Please note: If you are a national or resident in a country that already has a national association or federation affiliated with GWI, please apply for membership directly with them. GWI affiliate national members.

All fields marked with (Required) are required fields

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Personal Information
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Title: MissMrsMsDr

Name in full: (Required)

Name under which degree obtained, if different:


Street: (Required)

City: (Required)

State:

Postal Code: (Required)

Country: (Required)


Telephone:

Fax:

Skype ID:

Your Email: (Required) - Example: cindy@gmail.com


Nationality: (Required)

Year of birth: Example: yyyy-mm-dd


Profession: (Required)

Present Occupation: (Required)

Languages spoken:

Languages written: (Required)


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Education Information
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1.

University or Institution/Location: (Required)

Years attended: (Required)

Degree awarded: (Required)

Year Awarded: (Required)


2.

University or Institution/Location:

Years attended:

Degree awarded:

Year Awarded:


3.

University or Institution/Location:

Years attended:

Degree awarded:

Year Awarded:


Special field(s) of study:


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Other Information
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How did you learn about GWI?:

Why do you wish to become a member?:

Have you ever been a member of one of GWI's national federations or associations?(Required)
YesNo

If yes, which one?

Please indicate which payment method you will use to pay for your GWI 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 PaypalBank transfer


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

Signed: (Required) - Example: Cindy Grenfell

Date: (Required) - Example: yyyy-mm-dd


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Permission for name and e-mail Address to be included in the GWI E-mail Network
and to be shared with other GWI Members

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1. Are you willing for your e-mail address to be included in GWI's International Member Network? (Required)
YesNo

2. Are you interested in having contact with other interested university women in your own country? (Required)
YesNo

3. Are you interested in having contacts with GWI members from other countries? (Required)
YesNo


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Submit your form
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Click the "Send" button below ONCE to submit your form to GWI 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 licking "Send".

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