Virginia Gildersleeve
   
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Membership

Application for Membership in WG-USA

Before completing this form, please check to see if your degree, diploma, certificate or other qualification meets WG-USA's eligibility requirements.

Already a Member? If you wish to modify your member record, please contact the Membership Chair at membership@wg-usa.org. Please include your membership number, your full name and address and a description of the information you would like to change.
The following field(s) are(is) required: First Name, Last name, E-mail, Granting Institution, Degree Held, Street, City, State, Zip, Country

Names: Miss Mrs Ms Dr

*First name :
*Last name:
Your name as printed on degree
(ie. maiden,married):

Address:

*Street
*City
*State
Country
*Zip:
   
Telephone:
Cell:
Fax:
    
*E-mail:

Professional Information
Profession:
Present Occupation:

Degrees(s) held:

Names of Granting Institutions Degree held

* required
*required
Other Degrees Held:

Special Field(s) of Study

Interests and Talents

Do you belong to another affiliate of IFUW? If so which?

Languages Spoken (besides English):

Languages written (besides English):

International Connections or Memberships

How did you learn about WG-USA?

You have my permission to contact me by e-mail with membership renewal and membership meeing information stipulated in the WG-USA bylaws

Declaration: I declare that I hold the degree(s) stated. I subscribe to the purposes of WG-USA as set out on this web site will pay the annual membership dues of $50.

Information will be kept confidentional and will not be distributed
for purposes other than WG-USA Membership

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, please contact communications@wg-usa.org.
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