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: __________________________________________________
________________________________________________________________
________________________________________________________________
* Tel: _______________________
Fax: _________________________
* E-mail (Personal only – No UN address)1:______________________________
In an emergency contact:
____________________________
Last Position held:
Tel:__________________________
Organization:
_____________________________ ___________________________________
Service began: ________________ Ended: _____________________________
Nationality: __________________ *DoB: (DD/MM/YYYY)______________
Languages: _______________________________________________________
* Required fields
2.
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
1
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last updated 1 July 2015
* Eligibility is membership in another UN retiree association.
Please indicate name of primary associat
Please make cheque payable to Treasurer AFICS/NY in US dollars drawn on a US bank.
3.
Information for AFICS/NY
For List of Members (optional)
Please give a short description of your international career:
Organization; no acronyms
Dates - From/To
__________________
____________________
__________________
____________________
__________________
____________________
__________________
____________________
Information on your present occupation if any
_________________________________________________
_________________________________________________
4.
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)
______________________________________________
______________________________________________
Area(s) of expertise
______________________________________________
______________________________________________
Concerns/issues you wish AFICS/NY to address
______________________________________________
______________________________________________
last updated 1 July 2015
MINI-SURVEY:
1. Do you have a computer at home?
Yes [ ]
No [ ]
2. How often do you use your email? Daily [ ] Weekly [ ] Monthly [ ] Rarely [ ] Never [ ]
3. Can you print documents in PDF or Word format? Yes [ ]
4. How often do you use Internet?
Daily [ ]
No [ ]
Weekly [ ] Monthly [ ] Rarely [ ] Never [ ]
5. How often do you access the AFICS/NY website?
Daily [ ] Weekly [ ] Monthly [ ] Rarely [ ] Never [ ]
Signature:
Date:
___________________________________
___________________________________
Return to: AFICS/NY, Room DC1-0580
United Nations
New York, NY 10017, USA
www.un.org/other/afics
last updated 1 July 2015