Join or update details

Join the high-flyers and become part of the ub)alumni crew

Please fill out the online form below and click on submit details at the bottom of this page.

Alternatively, print the application form and fax to +61 3 5327 9855 or email your details to alumni@ballarat.edu.au

 I wish to become a member of ub)alumni
      (complete section 1 and sections 2 / 3 / 4 / 5 as appropriate)

 I would like to update my details
      (complete section 1 only)


Section One (1) Personal and Employment Details

Personal Details
Title: *
Family Name:*
Given Names: *
Former Name: (if different than at graduation)
Date of Birth: (optional)
Street Address:*




Town / Suburb:*
State:*
Post Code:*
Country: *
Telephone: (home)
Mobile: (personal)
Email:* (personal)


Employment Details
Position Title:
Occupation:
Employer:
Business Street Address:




Town / Suburb:
State:
Post Code:
Country:
Telephone: (business)
Mobile: (business)
Email:* (business)
Professional Associations / Societies:
 
  
How would you like to receive ub)alumni related emails: *
Personal email address
Business email address
Not at all / I would like to unsubscribe

How would you like to receive ub)alumni related hardcopy publications / correspondence: *
Home address
Business address
Not at all / I would like to unsubscribe

I give permission for my contact details to be passed onto relevant ub)alumni Chapters and Networks to enable me to be advised of networking and other activities in my geographical area or field of interest *
Yes
No

Are you willing to have your email / mailing address made available to other alumni? *
Yes
No

Please select the appropriate option/s: *
Current Student (Complete section 2 below)
Graduate (Complete section 3 below)
Current / Former Staff Member (Complete section 4 below)
Friend of the University (Complete section 5 below)
Please ensure you have provided all relevant details in the sections above


Section Two (2) For Current Students Only
Student Number:*
Course/s Studied:*




School/s:*




Campus:* (eg. Mt Helen, SMB, Ararat)
OR  
Provider:*(eg. MIT, IIBIT, Sino, Unity)
and  
Provider Location:*(eg. Melb, HK, Malaysia)
Year of Commencement:*
UB Associations/Societies you are a member of:



Section Three (3) For Graduates Only
Student Number: (if known)
Course/s Studied: *




School/s: *




Campus: * (eg. Mt Helen, SMB, Ararat)
OR  
Provider: * (eg. MIT, IIBIT, Sino, Unity)
and  
Provider Location: * (eg. Melb, HK, Malaysia)
Year of Commencement:
Year of Graduation: *
UB Associations / Societies you were a member of:



Section Four (4) For Current / Former Staff Only
Years of Employment From:
To: (if former staff member only)
Current or Last Position Held:
School / Section: *
Institution: * (eg. UB, Wimmera Institute of TAFE, BTC)
Campus: (if relevant)



Section Five (5) For Friends of the University Only
Current or Former Affilliation with the University: *
(eg former Council member)




Privacy Statement: All alumni information will be handled in accordance with the University's Information Privacy Policy.