City Women's Network, London

APPLICATION FOR MEMBERSHIP OF CITY WOMEN'S NETWORK

(All asterisked fields are mandatory.)

How did you hear of the London City Women's Network?*

Membership status *

Has your company offered you membership as part of a corporate membership program?

yes

Personal Data ( Please DO NOT use any accents (é,à,ç,â etc)!

First Name*:

Last Name*:

Address*:

Post Code*:

City*:

Country*:

Date of Birth*:

1st Nationality*:

2nd Nationality:

Ethnicity:

Home Phone*:

Personal Email*:

University (1st degree)*:

Graduation field*:

University (2nd degree):

Graduation field:

Number of children:

Which languages do you speak / read / write*?

What is your mother tongue*?

Professional/ Corporate Information

Function*:

Company*:

Type of employment*:

if "other" please specify

Market Sector:

Address:

Post Code:

City:

Country:

Phone:

Fax:

Mobile:

Email:

Website:

Have you already attended a CWN meeting? If so, please give details.

Do you belong to other networks? If so - which ones?

Do you belong to one of the affiliated networks?

TIAW

EuropeanPWN

Name of my proposer:

Name of my seconder:

Please remember to ask your proposer and seconder to complete their forms, which they can find in the members’ area of the CWN web site. They must submit them on-line or send them direct to the Adminstrative Office as they are confidential.

Do you serve on any boards? Are you interested in boards?

What are you looking for in joining us? Which of our committees (Business, Marketing, Membership, Personal Development and Social Activities) would you like to join?

For networking purposes, please supply a short biography (max 200 words)* which will appear on the reserved-access Members' Directory:


The data you provide on this form will be received by the EuropeanPWN Application Status Centre who will transmit it to the London City Women's Network Administrative Office (admin@citywomen.org). It will not be disclosed by either the EuropeanPWN Application Status Centre or the London City Women's Network to any third party, and will be used solely for administrative purposes.

I have understood the information provided above and authorise the use of the personal information contained in my Application Form.*

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	This field further helps prevent automated access.

Please submit this form. We will get back to you shortly.

If you have any questions, please contact us at admin@citywomen.org.