Association of Former International Civil Servants/New York

MEMBERSHIP APPLICATION FORM

I wish to become a member of AFICS/NY

  1. Basic Data

Name (Last, First) and title (Mr., Mrs., Ms., etc.)Gender: M F

* Staff member Former Staff member Spouse

Spouse’s name: ______

*Mailing address: ______

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______

*Tel: ______Fax: ______

*E-mail (Personal only – No UN address) ______

In an emergency contact:

______Tel:______

Last Position held:Organization:

______

Service began: ______Ended: ______

Nationality: ______*DoB: (DD/MM/YYYY)______

Languages: ______

*Required fields

  1. Type of Membership (check one):

Full member Life US$400.00 Annual US$45.00

Associate member:* I am a Life/Annual Member of (Name of Sister Organization): ______and wish also to become an

Associate member of AFICS/NY on the same basis:

 Life US$200.00 Annual US$25.00

*Eligibility is membership in another UN retiree association. Please indicate name of primary
association and provide membership number.

…/

  1. Information for AFICS/NY

For List of Members (optional)

Please give a short description of your international career:

Organization; no acronymsDates - From/To

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Information on your present occupation if any

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  1. Volunteers needed:

Please list AFICS/NY activities in which you would be willing to participate. If possible, indicate any specific area of knowledge or skill you would like to offer.

PensionHealth insurance

SocialAgeing

Outreach (elder care)Legal

 MembershipEditorial work

Communication/ITOffice work

Graphic designSpeaking engagements

 NGO Relations & InformationOther (add below)

Organizing panel discussions, seminars

 Other (add below)

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Area(s) of expertise

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Concerns/issues you wish AFICS/NY to address

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Signature:______

Date: ______

Please make cheque payable to Treasurer AFICS/NY in US dollars drawn on a US bank.

Return to:AFICS/NY, Room DC1-0580

United Nations

New York, NY10017, USA

Tel: 212-963-2943

Email:

Website:

last updated October 2016