Membership Form
Download Memebership Form (here) or complete it on line.
Membership Form
ICW is the only international network run by and for HIV+ women. It was founded in response to the desperate lack of support and information available to many of us world-wide. ICW exists to promote the voices and improve the situation of HIV positive women throughout the world. According to our principles, membership to ICW is individual and free and open to all women living with HIV/AIDS. For other women, men or groups, there are different categories of membership, as detailed below. Join us today by completing this form!. Remember * is mandatory.

I would like to join ICW as a Member (woman living with HIV). *
YES
NO

IF Not (please indicate which category of membership you are requesting): *
Friend of ICW (supporters of our work and those with friends and/or family members with HIV)
Positive women’s organization
Network of PLWHIV
Organization

First Name * Family Name * Year of Birth *


Address where you can receive our correspondence:

Town * Post code/ZIP code: Country *

Telephone Fax E-mail *


Additional contact information:

Members and Friends:
- Are you open about your status?
YES NO
- Are you also living with a co-infection (i.e, TB, Hep C…) and if so which?

- Are you involved with a + women’s network and/or HIV related organization.
YES NO
If Yes, which?
 
- What is your gender? *
Famale Male Other
- In which language would you like to receive information from ICW?
English French Spanish Others
- Do you want to share your name and address to relevant organizations that works in the field of AIDS?.
YES NO

- We will send the information via e-mails
– unless otherwise indicated by ticking box
 
Information given in this form will be kept confidential by ICW unless otherwise stated.
We would really like to know more about your experiences of living with HIV. Please use this space to tell us about your daily life, work, opinions, particular concerns, family or other areas of life that you would like to share with us. If you would like to tell us more, please attach another sheet of paper!

We would really like to know more about you. We would so much want to involve members in advocacy activities, programs and many times we receive requests from our partners for persons with specific skills and expertise to support their work. In this case, information about a recommended member has to be shared beyond the person managing this information at the secretariat. This shall however happen with members consent.
Please indicate whether you are happy for the information you write here to be:
- Included in ICW publications
YES NO
 
- Partners.
YES NO
- Shared with staff only.
YES NO
 
- Publically.
YES NO
- Put on the website.(accessible to anyone with internet access).
YES NO
 
- Members in the region and Internationally
YES NO

We would also like to know what areas of HIV and related issues are of particular interest to you and why.
Violence against women (VAW) GIPA New Prevention Technologies
Access to Care, Treatment, Support Income Generation Co-infection/s
Access to Medication Children and HIV Adolescents and HIV
Commercial Sex Work Issues of Sexual Identity Religious Issues
Migration/Mobile populations Drug and Alcohol Use Disability and HIV
Sexual and Reproductive
Health / Rights
Conflict and Flight
from Home
Women in Prisons and
Other institutions
Any Other?

Can you tell us something about your interest/experience in these areas?

For involvement, engagement purposes, what areas would you like to be engaged in (if you could highlight areas where you have expertise, are skilled and experienced


What is your native language ? Please specify *

What other languages do you speak? Please specify

Please sign here: I wish to become a member of the International Community of Women Living with HIV/AIDS.
SIGNATURE * : . Please, complete with your name.

Please be assured that this information is treated as private and confidential.
 
 


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