MEMBERSHIP REGISTRATION FORM 2017
Family Name Click here to enter text. First Name Click here to enter text.
New Member Yes or No Country of Origin Click here to enter text
Street Address Click here to enter text.
City Click here to enter text. Postal Code Click here to enter text.
Country Click here to enter text.
Preferred Phone Number Click here to enter text. Number type: Mobile or Landline
Email address Click here to enter text.
Organization Choose an item.
For Permanent Mission, Embassy, or Other please provide detail Click here to enter text.
Status Choose an item. Do you have a VIC grounds pass? Yes or No
Number of Grounds Pass Click here to enter text. Color of Grounds Pass Click here to enter text.
UNWG will use your email address for most communications, including the electronic newsletter.
If you do not wish any UNWG communications to be posted to the above mailing address, please check this box. ☐
If you wish to restrict publication of some part of your registration information, please indicate which items Click here to enter text.
If you wish to receive a hardcopy of the Newsletter for an extra charge, please check this box. ☐
ABOUT YOU
Languages spoken Click here to enter text.
Professional experience Click here to enter text.
Hobbies Click here to enter text.
Would you like to work as a volunteer in any of these areas:
☐ Kiosk ☐ Charity Shop ☐ Book Shop ☐ Fund Raising ☐ Coin/stamp sorting ☐ Bazaar
☐ Charity Project Review ☐ Other Click here to enter text.
BANK TRANSFER DETAILS
Account name: UNWG IBAN: AT73 1200 0503 4726 5501 BIC: BKAUATWW
20 € for Membership 20€ for Hardcopy Newsletter
Please put the member’s name in the comment field of the Bank Transfer
For Office Use Only
Membership Number