GWDFC MEMBERSHIP INFORMATION SUBMISSION

Please fill in the form below and then submit.
You must give a real name and birth date. The date is only needed to assure that
you are at least 18 years of age (minimum age for membership).

For many years the GWDFC has included a "CICN" (Common Interest Correspondence Network) listing in one newsletter a year. The
name, address, birthday (not year) and interests of participants are included so that club members with common interests may write to each
other if they wish. This address/information list will now be available to members on the members-only section of the club website.
Do you want your information included in the CICN listing?   YES       NO

First name (required)
Last name (required)
E-mail (required)
Nickname (optional)
Address1
Address2
City, State, Country
Post or Zip code
Actors and/or Actresses Name 3 favorite
Movies and/or TV shows Name 3 favorite
Books/Authors/Music Name 3 favorites
Hobbies