AIWC Genoa Test Site

Username *

Email Address *

First Name *

Last Name *

For which type of membership are you applying? *
Full MemberAssociate/International Member

Date of Birth (please use format dd/mm/yyyy) *

Cell Phone *

Home Phone

Current Street Addresss *

City *

State *

ZIP Code *

Nationality *

English Language Ability *
Mother Tongue   Good   Fair

What is your profession?

Are you currently employed?
Yes   No

If yes, where are you employed?

Spouse's Name

Spouse's Nationality

Do you have children? *
Yes   No

Child #1

Child #2

Child #3

Child #4

How long have you lived in Genoa? *

If you have just arrived, please state where you were living before and your reasons for coming to Genoa.

How did you hear of the club? *

What do you hope to gain from membership? *

What are your hobbies / Interests?

Membership participation in club activities is desirable. In which areas would you be interested in becoming involved? *
Teas / Coffee mornings / General Meetings   Book Club   Handicraft Groups   Club Administration (Bulletin, Treasury, etc.)   Burraco (card game)   Special Events (Dances, Dinners, etc.)   Charity Fundraising Events (es. Christmas Bazaar)   Club Outings (tours, shows, walking tours)   English / Italian Conversation   Moms & Tots

Other (please write other desirable activity)

I hereby authorize American International Women's Club of Genoa to publish the photographs taken of me, and my name, for use in the PUD’s printed publications and website. I acknowledge that since my participation in publications and websites produced by American International Women's Club of Genoa is voluntary, I will receive no financial compensation. I further agree that my participation in any publication and website produced by American International Women's Club of Genoa confers upon me no rights of ownership whatsoever. I release American International Women's Club of Genoa, from liability for any claims by me or any third party in connection with my participation. *
Yes   No

Registration confirmation will be emailed to you.