Membership Application

First Name*

Last Name*

Email Address*

Home Phone Number

Cellular Phone Number

Physical Address

Apartado Number

City / Neighborhood

Postal Code

Were you a previous member of WCCR?

Yes

No

What was your last year of WCCR membership?

List the last year you were a member of WCCR

Will you reside in Costa Rica year-round or seasonally?

All year-round

Only seasonally

Is there a committee you would like to help or receive more information about?

Neighborhood Tea’s

Fundraising / Special Events

Membership

Public Relations

Programs

Choose as many options as you would like

Are there any Community Service inititavies you would like more information about?

Reading is Fun!

University Program

Women’s Initiatives

Would you like to receive news, updates and invitations from the PWN?

Yes

No

Application for Membership