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Home » Independent membership » Application Form

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.

Step 1 of 5

20%

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
Date Format: 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*
Date Format: 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

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