APPLICATION FOR MEMBERSHIP

 

Canadian Federation of University Women Victoria

A member of CFUW and IFUW

 

 

NAME                 _______________________________________________________________________________

                                                                  Surname                                       (Given Names – underline preferred name)

 

MAIDEN/BIRTH NAME                     ______________________________________________________________

 

ADDRESS                                    ______________________________________________________________

                                                 

                                                  ______________________________________________________________

                                                  City                                                                                                                                                 Postal Code

 

TELEPHONE (home)                     ___________________________ (business) _________________________

 

EMAIL                                         _____________________________________________________________

 

UNIVERSITY                                       Degree obtained   Year         Name under which obtained

                        

_______________________________     ________      ______    ___________________________________

 

_______________________________     ________      ______    ___________________________________

 

_______________________________     ________      ______    ___________________________________

 

PROFESSION                                _____________________________________________________________

 

CURRENT WORK (paid or unpaid)  ______________________________________________________

 

Have you ever been a member of CFUW of IFUW before?            Yes [  ]                                        No [  ]

 

Club names        _____________________________________________________    Date  _____________

 

                         _____________________________________________________           _____________

 

                         _____________________________________________________           _____________

                        

 

LIST ADDITIONAL EXPERTISE/INVOLVEMENT (including Boards/School/Volunteer/Community)

_____________________________________________________________________________________

_____________________________________________________________________________________

                        

I certify the above to be true and consent to the collection of this information to be included in the club directory. and data base (for internal club use only).

_________________________________________________________________________________

                                                                           Signature                                                                                                                Date

 

Application accepted by             ______________________________________________________

                                                                                                    Club Membership Secretary                                     Date

 

Dues for 2008-2009 are $100.00.  Please make your cheque payable to CFUW Victoria and mail to:

                         CFUW Victoria  Membership, 1581–H Hillside Avenue, Ste. #227, Victoria B.C. V8T 2C1