Name ____________________________

Address __________________________

_________________________________

_________________________________

Post/zip code ______________________

Country ___________________________

Telephone _________________________

Fax ______________________________

email ____________________________

Year of birth _______________________

Occupation (job etc) _________________

(Delete the following as necessary)

I wish to be a visitor and/or hostess

I live in a flat/house/cottage/other

__________________________________

Situated in a city/town/village/suburb/other

Nearest city/town:

__________________________________

I live with my husband/partner/parents/ friends/child(ren) if under 16, date of birth 

__________________________________

Religion (if important to you) ____________

Mother tongue _______________________

Other languages spoken ________________

___________________________________  

  - a member with her husband/partner    yes/no

  - a member with her children            yes/no

  I am : smoker/non-smoker/hate smoking

  My chief interests are :- 

  ________________________________________

  ________________________________________

  ________________________________________

Please, do not include travel/other cultures/people. 
We assume you are interested in these because you    want to join!)
Recommended minimum donation is £35 sterlingfor new members (if for bona fide reasons it is impossible to send this amount, write to the 5W office). £35 covers the cost of the membership list and three newsletters per year. Your generosity helps us to enrol members in countries from where they cannot send donations.
I enclose my donation of : ___________________
I would/would not like to make a friendship donation:________________ (every little helps)
Cheques payable to 5W - £ Sterling, Aus/Can/US $, Euros (sorry, no eurocheques) . Payment may be made by debit/credit card using the form provided.

I heard about Women Welcome Women World Wide 
from :-
__________________________________________

Membership Pledge

I understand that the data from my application form will be put on the 5W computer and that it will be given only to other members of 5W. I will not allow any unauthorised access to my list, and I understand that any proceedings arising from breach of this condition will be governed by UK law.

Women whose first language is not English are advised to obtain a translation of the above before signing.

Signed :- _________________________________

Date :- __________________________________