The Cambridge Society of NSW
                                                                   ABN 90 499 855 279
                                                                                             Administrator
                                                                        56 Edgecliff Road, Woollahra NSW 2025
                                                                             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: ______________________      Mobile: ______________

Email (Our preferred means of contact): _______________________________________________________

Cambridge Details

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’, 56 Edgecliff Road, Woollahra, NSW 2025.

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: Cambridge Society of NSW

BSB: 112 879

Account No: 036-502-926

By making this application and becoming a member of the Society the member explicitly consents to the Society obtaining, recording and holding his or her personal data (including sensitive data) for the purposes of the Society either by electronic means or in an organised manual filing system.  This information may include the member's full name and address and, where applicable, telephone and fax numbers and e-mail address.  The member consents to the Society disclosing full name and address to other members and to the University, and such disclosure may also include the member's telephone and fax numbers and e-mail address, unless the member has expressly excluded this by written notice to the Secretary.