The
ABN 90 499 855 279
Administrator
Phone: 9386 4889, mob: 0424 243369
The
ABN 90 499 855 279
Administrator
Phone: 9386 4889, mob: 0424 243369
Email: tomsuzieruse@smartchat.net.au
Membership
Application / Subscription
Renewal Form
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:
OR (If you wish to use direct debit)
I,
_____________________________, hereby authorise
(_____________ bank name of
__________________________) to electronically transfer to Cambridge
Society of NSW BSB 112 879 Account No: 036 502 926 my annual
subscription of $40 (or any increase ratified by subsequent AGMs) on 1
January until future notice debiting my Account with this amount each
year.
My account details are BSB__________ Account No:_____________
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.
