Association loi 1901. N° 2506




Name:    ________________________ (first name for your name brooch if different): ________________

              BLOCK CAPITALS






Tel: __________________________________ Mob: ______________________________________________


Email: __________________________________________             Date of Birth: _______ /______ /_______


1.  What is your nationality? ________________________________ 


2.  Have you been a member of the DLCI in the past?          *No          *Yes         from _______ to ________  


3.  Please list any countries you have lived in for more than 6 months: 




4.  How long have you lived in France?   ________________________________________________________


5. If you speak French, how would you rate your ability? 


                      Fluent   □        Reasonably fluent   □         Not very fluent   □


6.  Please give details of voluntary/work experience/professional qualifications (e.g. nursing, accountancy etc.) 

including any special skills/attributes you may have:










7.  What are your major interests? 








8.  Would you be willing to give a short talk at a DLCI Lunch (Max 20 mins)?      Yes □    No □


     If yes, on what topic/s? ___________________________________________________________________


9.  Are you willing to help in any way with fundraising?         Yes □    No   □





10. Would you be willing to hold a DLCI Coffee Morning at your home?        Yes   □     No   □



11.  How did you hear of the DLCI?  If through a current member, please give their name: 




12.  Please tell us if you live alone; this is for Welfare purposes only:           Yes   □    No   □   


13.  We like to ask our new members to give us a short profile/background information.  Please let us know a bit more about yourself, for example: married 25 years to John, 3 children, 4 grandchildren, moved to France to escape the traffic, enjoy doing … I get involved in…… etc...  There is no problem if you would prefer not to give such information.















  • For the comfort and health of all our members no smoking is permitted at any meetings or events - even if it is outdoors.  
  • The details from this application will be stored on the DCLI electronic database. 
  • The membership directory is confidential to members of the DLCI and should not be used for commercial purposes or passed to those outside the Club.


By signing this application form I give my permission for my contact details to be made available to other members in the form of an electronic membership directory.



Signature: ___________________________________________             Date:  ________________________



The annual subscription is currently €25. For new members, the subscription is on a pro rata basis of 2€ a month, starting April 1, plus 1€ for the initial administration. Please check with the Membership Secretary if you are not sure what you should pay.


Please return this form (with a cheque made out to “DLCI” for the subscription) to:


Sue Heyes, Membership Secretary,

 Dordogne Ladies Club International, 

Lacoste-bas, Fongalop, 24170 Belvès




NB:  Highlight the above text and copy and paste into a word document or pages (for Mac) then print off

Registered Office

Dordogne Ladies Club International
House Bergerac Associations

Place Jules Ferry



Association loi 1901 No. 2507

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