THE OFFICIAL GERAINT WYN DAVIES FAN CLUB

MEMBERSHIP APPLICATION FORM Join, renew, rejoin (lapsed membership) or to update membership information using this form. Fill in the data and submit using the button at the bottom of the form.   Click the PayPal icon & use the "send money" option to send dues  to "quinn @ gwdfc.org", then fill out the form & submit. Dues are $17 for US members, $19 for Canadian, $22 for all other countries. Don't use PayPal?  Need a form for snail mailing? Click one of these formats: Microsoft Word version (.doc)                    Adobe Acrobat version (.pdf)

PLEASE CHECK ONE:     New Membership     Updating Information     Renewing     Rejoining

Mailing information (below) MUST be filled out!

Mailing information (required):

First Name:               Last Name:

Address #1:

Address #2:

City:                  State/Province:

Country:                                Zip/Post Code:

E-Mail:

Interests (optional):

Birthday:  
                   Must list as Month-date-year! Year is only to assure that new members are at least 18.

Favorite actors/actresses:

Favorite movies/TV shows:

Favorite authors/books/music:

Pets/Hobbies:


Comments, questions, etc. (anything else you'd like to tell or ask us:

 

CICN (response required):

The GWDFC has, for many years, included a "CICN" (Common Interest Correspondence Network) listing
in one newsletter a year. The name, address and interests of participants are included so that members with
common interests may write to each other if they wish. Do you want your information included in the CICN?

YES, I wish to be included in the next CICN.

NO, I do not wish to be included in the CICN.

                          

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