Date: Thu, 23 Dec 1993 21:32:55 -0800 (PST)
From: Jeff Herwatt <jherwatt@netcom.com>

                  Application Form for membership in IGLYO





Thank you for your interest in the International Lesbian Gay
Youth Organization. IGLYO would like to welcome you to the world
of international lesbian gay youth. To begin your membership in
IGLYO please completely fill out the form below using a
typewriter whenever possible.

Name of Group:

Contact Person:

Care of (If needed):

Street Address:



City:                                   State:

Postal Code (ie: Zip code - if possible Zip+4 for US addresses):

Telephone Numbers:

Voice (if out side the USA please include all city and country
codes):

(       )          EXT:

FAX:

(       )

Group Information

*Individual Memberships do not need to fill this section of the form out*

Type of Group:

>Local         > Regional              > National

Affiliation:

> Independent           > Part of a Regional or National Group

Membership:

Number of Female members:

Number of Male members:

Number of members 27 years old and over:

Membership make-up:

Does your group consider itself as (please pick one):

> Lesbian               > Gay           > Bisexual              > Mixed

Membership type:

Are you applying for FULL membership in IGLYO:  > YES   > NO

>Note: To determin the membership category that is proper for
your group please consult the membership information sheet
included in this pack.



>Remember only FULL membership gives you the chance to determine
IGLYO policy!

                    _______For Office Use Only_______

Membership Number:         Invoice Number:      Rec\Exp. Date:    Chk.
Other: