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Register Your Details

Register/Update Your Details

Relationship	Graduate	Staff	Former Staff	Student	Former Student	Friend
Surname
First Name
Middle Name(s)
Title	or Other
Maiden/Former Name
Student/Staff ID Number (if known)
Gender
Date of Birth	dd/mm/yyyy
Marital Status
Home Address


Suburb/City
State/Province
Postal Code/Zip Code
Country
Country of Birth
Email Address
Home Phone Number
Mobile Phone Number
Employer
Business Address
Business Phone Number
Industry
Job Title
If you would like to subscribe to any of the following publications, free of charge, please tick the relevant boxes:
Electronic Publications *Adelaide-Link* (the University's alumni e-newsletter, published every 2 months) *Adelaidean Online* (the email list for the University's newspaper, published monthly from March to December) Email Address: As Above or Other			Hard Copy Publications *Lumen* (the University's alumni magazine, published in June and December) Preferred Mailing Address: Home or Business
Qualification 1:
University Name
Faculty of
Degree
Major
Graduation Year
Qualification 2:
University Name
Faculty of
Degree
Major
Graduation Year
Qualification 3:
University Name
Faculty of
Degree
Major
Graduation Year
Qualification 4:
University Name
Faculty of
Degree
Major
Graduation Year
If you wish to become a member of a particular alumni group, please indicate below. (please tick as many as you like)
Discipline Related Alumni Groups			Regional Alumni Groups
Sir Joseph Verco Dental			University of Adelaide Alumni Sydney
Florey Medical			University of Adelaide Alumni Malaysia Bhd
Roseworthy Old Collegians Association Inc (ROCA) *membership fees apply			Sarawak Alumni of the University of Adelaide
Cornell (Arts/Performing Arts)			Adelaide University Alumni Association Singapore
Architecture and Planning			University of Adelaide Alumni Association UK
John Bray Law			University of Adelaide Alumni Association Hong Kong Inc
MBA Alumni Association			Melbourne Network
Commerce			Thailand Network
Entrepreneurship and Commercialisation			United States Network
Interest Related Alumni Groups
Adelaide University Sports Association Inc *membership fees apply
Friends of the University of Adelaide Library (please choose one) Email Post
Please indicate ways in which you may wish to offer your help and support to the University of Adelaide. Which of the following would you like to receive more information about? (please tick as many as you like)
Becoming a member of a volunteer committee			The Vice-Chancellor's Scholarships Annual Appeal
Being a key speaker			The Heritage Foundation Appeal
Helping to develop useful networks			Providing a scholarship
Sponsoring activities			Making a bequest
The Barr Smith Library Annual Appeal			Other ways of giving to the University
By submitting this form, you agree that all information provided on this form may be added to the University's Development and Alumni database for University and University related purposes and for the University to maintain contact with you. The information may be passed on to third parties within and outside Australia for the purposes outlined above, but only if they are directly affiliated with the University or if they require the information to perform services for the University. Thank you for completing this form.