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WomenSport International
Make a paper copy of this application, complete the requested information, and mail with payment to the address at the bottom of the form.
| Title: | Dr. ____ Mr. ___ Mrs. ____ Ms. ___ Miss ____ |
| Family Name: | _____________________________________________________ |
| First Name: | _____________________________________________________ |
| Organisation: | _____________________________________________________ |
| Postal Address: | _____________________________________________________ |
| _____________________________________________________ | |
| _____________________________________________________ | |
| _____________________________________________________ | |
| Tel.: | (______)______________________________________________ |
| FAX: | (______)______________________________________________ |
| Email: | _____________________________________________________ |
Please circle membership category (refer to list below
| Category | Band A Countries | Others |
| Organisation (1 yr) | $200 | $200 |
| Organisation (4 yrs) | $600 | $600 |
| Individual (1 yr) | $50 | $30 |
| Individual (4 yrs) | $150 | $90 |
| Individual (Lifetime) | $500 | $500 |
| Student (1 yr) | $25 | $20 |
| Prices listed in US dollars |
Band A Countries:
Andorra, Australia, Austria, Aruba, Bahamas,
Bahrain, Belgium, Bermuda, Brunei, Canada, Cayman Islands, Channel Islands,
Denmark, Faeroe Islands, Finland, France, French Polynesia, Germany, Greece,
Greenland, Guam, Hong Kong, Iceland, Isle of Man, Israel, Italy, Japan,
Korea, Kuwait, Lichtenstein, Luxembourg, Macao, Malta, Monaco, Netherlands,
Netherlands Antilles, New Caladonia, New Zealand, Norway, Portugal, Puerto
Rico, Qatar, San Marino, Singapore, Slovenia, Spain, Sweden, Switzerland,
United Arab Emirates, United Kingdom, United States, Virgin Islands (US).
| Methods of Payment | |||
| 1. | Please debit my credit card | ||
| I authorize payment to WomenSport International Inc. | |||
| $ _________________ for membership $ _________________as a donation towards the work of WSI |
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Bankcard
Mastercard
Visa |
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| Cardholder name: | __________________________________ | ||
| Signature: | __________________________________ | ||
| Expiry: | _________/_________ |
Card code verification (last 3 digits on signature panel |
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| 2. | Cheque/money order | ||
| I enclose a cheque/money order in (USA $) made payable to WomenSport International Inc. | |||
| $ _________________ for membership $ _________________ as a donation towards the work of WSI |
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| 3. | Electronic Money Transfer | ||
| Banking details: | US Bank, 9910SW Bank Road, Vashon, WA 98070, USA | ||
| Account name: | WomenSport International | ||
| Bank no: | 1-25000-105 | ||
| Account no: | 1-535 0087 8977 | ||
| Return application form to: | Carol Rodgers PhD College of Kinesiology, University of Saskatchewan 87 Campus Drive, Saskatoon SK, Canada S7N 5B2 |
P.O. Box 743
Vashon, WA
USA