World Association for Sexology
Application for Admission
(Societies, Institutes, Groups)

For Internal Use

Application Number:

Amount Received:

Approved:

Replied:

Date: _________________________

Name of Organization: _____________________________________________________

Date of Founding: _________________________________________________________

Purposes and Objectives:

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Address:

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Telephone: _____________________________ Fax: _____________________________

Mailing Address:

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Number of Members: ________________________________________________________

Names of the Principal Directors, indicating their respective positions:

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Does the Society or Institution publish a periodical, journal or bulletin?

Yes: _____ No: _____ Title: _______________________________________________

Frequency: ________________________________________________________________

Please give us the names and address of each of the editors:

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