Application Type:
New MemberRenewal

First Name (required)

Last Name (required)

Street Address (required)

Postal Address (required)

Contact Details

Telephone (home)

Telephone (work)

Fax

Mobile (required)

Email (required)

Birthday (required)

Nationality (required)

Husband or partner’s first name & surname (if different):

Have you had any board or committee experience? If so, in what capacity?

Would you be willing to serve on the IWC Board?
YESNO

Would you be willing to assist in IWC activities?
YESNO

How did you hear about IWC?

Give your reason for joining IWC:

Interests:

Work Experience:

I agree not to use the Club or the Club directory for business purposes. IWC will not be held responsible or liable for any injury, loss or inconvenience while I am participating in any function, event or activity organised by IWC.

Date of Application:

Please attach a copy of your proof of payment for our records if you are paying by EFT:

1+1=?