CANADIAN WOMEN'S CLUB OF NEW YORK CITY, INC.
LE CLUB DES FEMMES CANADIENNES DE NEW YORK
MEMBERSHIP APPLICATION

Is this a directory profile change for a current member? Yes

Class of Member: Tri-state (NY, NJ, CT) Non-resident Student
Name:
Nee:
Address (home):
Address (work/other):
Telephone (H) (W) Fax:
(Please mail to: home work)
Email:
Industry/Specialization:
Education, Field & Year of Graduation:
Professional History:

In the New York area since (year): Birthplace:
Your Birthday (Month, Day)
Association with Canada: citizen friend spouse citizen other:
Mother's Birthplace:
Father's Birthplace:
Spouse's Name:
Spouse's Birthplace:
Spouse's address (work/other):
Spouse'sTelephone (work):
Language Proficiency:
Previous Countries of Residence:

Other Interests/Activities:

Memberships in Other Organizations:

Which club activities are you interested in: Cultural Events Social Events Scholarship Newsletter
Mentor Program Professional Development Other:
Please note one club sponsor:

Signature:_________________________________________ Date:_______________________

Membership Dues (Send check with application) $75. Tri-state member, $25. Non-resident or student Please Return to: Canadian Women's Club of NYC, P.O.Box 2896,Grand Central Stn,New York,NY 10163-2896

For official use: Approved by President (Signature):_______________________________Date:___________________