Application Form

Application for GWI Independent Membership

Please note: If you are a national or resident in a country that already has a National Federation or Association affiliated with GWI, we encourage you to apply for membership directly with NFA. However, GWI is also pleased to receive your independent membership. GWI affiliate national members.

Title*
- Miss
- Mrs
- Ms
- Dr
Name in full*
Name under which degree obtained, if different
Street*
City*
State
Postal Code*
Country*
Telephone
Fax
Skype ID
Your Email*
Nationality*
Year of Birth
MM slash DD slash YYYY
Profession*
Present Occupation*
Languages spoken
Languages written*

Education Information
1st University or Institution/Location*
Years attended*
Degree awarded*
Year Awarded*
2nd University or Institution/Location
Years attended
Degree awarded
Year Awarded
3rd University or Institution/Location
Years attended
Degree awarded
Year Awarded
Special field(s) of study

Other Information
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?*
- Yes
- No
Which one?

Declaration
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.
Signature*
Date*
MM slash DD slash YYYY

Permission for name and e-mail Address to be included in the GWI E-mail Network and to be shared with other GWI Members
Are you willing for your e-mail address to be included in GWI's International Member Network?*
- Yes
- No
Are you interested in having contact with other interested university women in your own country?*
- Yes
- No
Are you interested in having contacts with GWI members from other countries?*
- Yes
- No
I understand that I must complete the required payment after submitting this application, or it will not be considered successful.*
- I do

Application Form

Education Information

Other Information

Declaration

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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