Registration of Interest

Please complete the online form below and a membership brochure and application form will be forwarded to you.

Already registered your interest in membership?

Anyone that has sent a ‘registration of interest’ to the Club recently will receive a full membership brochure and application form at their nominated address.

Membership Type

	Individual (Alumni)
	University (UWA Staff)
	University (UWA Postgraduate Student)
	Associate (Spouse of Primary Member)
	Corporate

Title

First Name

Surname

Address

Suburb

Postcode

Contact Phone Number

Year of Graduation
(Individual Only)

Faculty, School or Department
(Individual & University)

How do you wish to receive further information?

	Email
	Post

CRICOS Provider Code: 00126G
Last updated 26 Mar 2009 12:01
Location: http://www.universityclub.uwa.edu.au/page/1239

The University Club of Western Australia

Registration of Interest