Federations

MEMBERSHIP INFORMATION

The information received will be held safely at the national office.

1. Name ____________________________________________

2. Address __________________________________________________

____________________________________________________

3. Telephone number ______________

4. Email Address ___________________

5. Fax number _________________

6. Institute ____________________

7. Federation _________________

8. Current Federation Office Holder:(Please tick)

___President ___Treasurer ___Secretary

9. Current Institute Secretary ____Yes ____No

10. Year of first joining W.I. _________

11. Year of Birth _________________

12. Dual Institute / Federation __________

13.Lone Member ____Yes ____No

14. National Awards___Gold Honours___Good Service

15. Current Home & Country subscriber____Yes___No