
The
ABN 90 499 855 279
Administrator
Phone: 9386 4889, mob: 0424 243369
Email: tomsuzieruse@smartchat.net.au
Membership
Application / Subscription
Renewal Form
If re-applying and your
details have not changed, please just complete
your name.
Personal Details
Title/Initials:
________ Given Name: _________________
Surname: __________________________
Address:
____________________________________________________________________________
Postcode:
__________ Country: _____________________
Phone:
_______________ Fax:
______________________
Email (Our preferred means of
contact): _______________________________________________________
Faculty:
___________________________________________
College:
___________________________________________
Year Graduated: _______________
Honours/Other
Degrees: ___________________________________________________________
Do you
permit your details to be included in the Society’s
Directory? Yes
[ ]
No: [
]
Do you
permit your details to be added to the alumni database held by
the
Cambridge University Development Office
Yes
[ ]
No: [
]
Fees
Annual Subscription:
……………………………………………………………… $40.00
Payment
Please
post this form to the above address with a cheque for $40 to
‘The Cambridge
Society of NSW’,
OR
Email the completed form
to tomsuzieruse@smartchat.net.au
and
make payment
by direct deposit to the Cambridge Society’s St
George Bank account
(please include surname on transfer)
Account
Name:
BSB: 112 879
Account
No: 036-502-926
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