Thank you for adding your voice to empower women by seeking to
join our club and become part of the larger globalcommunity of
Zonta International. Please submit the completed form to:
Member Type: Club member Reinstating member
Young professional (under
30 years of age)
First Name: Last Name/Surname:
Address:
City: State/Province (if applicable):
Postal Code: Country:
Home Telephone: Mobile/Cell Phone:
Email: Occupation/Title:
Date of Birth (DD/MM/YYYY): *Required for young professional
dues rate Gender: Female Male Other
I am a Zonta Education Award recipient (Please specify):
Amelia Earhart Fellowship Jane M. Klausman Women in Business
Scholarship Young Women in Public Affairs Award
I was a Z Club / Golden Z Club member (Please specify club and
country): ………………………………………………………
I am a former Zonta Club Member (Please specify club and
country): ………………………………………………………………
Please list your interests, skills, languages and other
affiliations:
Zonta International is a global network of more than 29,000
members committed to securing a world where gender
equality is a reality. Please confirm:
I am committed to upholding the mission, objects and vision of
Zonta International and I shall comply with the rules and polices
of Zonta International. Please email [email protected] if you
wish to view the governing documents which are currently located on
the “member only” part of the website.
I give my consent to the Zonta club to store the personal
membership information I have provided by applying formembership
and added during my membership years, including photographs taken
of me in connection with Zonta activity. I undertake to renew or
withdraw this consent on an annual basis.
I undertake not to sell, rent or disclose any member data
information in my possession, to any third party.
Membership
Application Form
MEMBER
mailto:[email protected]
February 2019
Member Type Dues (All levels)
Club Member
Young professionals (under 30)
Please Note: Members joining from 1 December – 31 May will pay
annual renewal dues by 1 June for the following year.
Notes: The Zonta year is 1 June - 31 May; Zonta Headquarters is
located in the USA. The new member / reinstatement fee is included
in the dues amounts above. North American Zontians pay an
additional US$3. Membership is not complete until both this form
and payment arereceived and processed. *Half-year dues rate for
members joining 1 December – 31 May.
Payment type Where to submit How to submit
We want others to learn about our work and join us. Please tell
us how you learned about Zonta International.
I learned about Zonta through:
A friend or family member Club/Zonta International website
Social media
Zonta education award Z or Golden Z Club Other: ……………………
Current or former Zonta member
Please provide the name and the best way to contact someone you
know who may be interested in joining Zonta:
Name: Phone/Email:
Signed:
Name (printed):
Date:
Thank you for completing this application form. Shortly you will
receive an acknowledgment.
For more information, visit www.zonta.org/join.
Classification Code: Date Received: Date Approved by Club:
Date Approved by Membership Committee: Date Submitted to
District:
DUES
PAYMENT
FOR CLUB USE ONLY
http://www.zonta.org/join
First Name: StateProvince if applicable: Postal Code: Country:
Home Telephone: MobileCell Phone: Email: OccupationTitle: Where to
submitCredit Card: How to submitCredit Card: Where to
submitCheckMoney Order: How to submitCheckMoney Order: Where to
submitCash: How to submitCash: Other: Name: PhoneEmail: Name
printed: Date: Classification Code: Date Received: Date Approved by
Club: Date Approved by Membership Committee: Date Submitted to
District: Last Name: City: Address: Gender: Other: OffGender: Male:
OffGender: Female: OffRecipient: YWPA: OffRecipient: JMK:
OffRecipient: AE: OffRecipient?: OffZ or Golden Z club member:
OffFormer Zonta club member: OffZ/GZ club and country: Zonta club
and country: Interests, skills, etc: Check Box 1: OffCheck Box 2:
OffCheck Box 3: OffFooter Address: Address | City/State/Country |
PhoneWebsite | EmailClub Member Dues: OffYP Member Dues: OffPayment
Type 1: (Ex: Credit Card)Payment Type 2: (Ex: Check/Money
Order)Payment Type 3: (Ex: Cash)Payment 1: OffPayment 2: OffPayment
3: OffCheck Box7: OffCheck Box8: OffCheck Box9: OffCheck Box10:
OffCheck Box11: OffCheck Box12: OffCheck Box13: OffDOB: Club's
email address: Member Type 2: OffMember Type 1: OffMember Type 3:
OffClub Logo: Club Member Dues_Amount: US$103/US$59*Young
professionals Dues_Amount: US$59/US$37*
