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40th Anniversary Registration Form

Fields marked with an * are required fields.

Alumni DetailsTitle First Names* Preferred Name Surname* Previous/Maiden Names Date of Birth* Iwi Please include me on the register of Māori graduates

EducationDegree/Diploma/Certificate and dates of study (eg BSc Honours 1992 - 1997)

StaffRole Years of employment

Current AddressPostal Address Suburb City State/Province Post Code Country Tel Fax Email

Alternative Address (for instance a parent or family address)Postal Address Suburb City State/Province Post Code Country

Employment History / InformationTell us about any paid/unpaid work you did.

What significant achievements have you experienced or events have transpired since you finished your studies?
(eg. community service, wrote a book, went into business)

We are all so bad at bragging about ourselves, so...please tell us about the successes of your friends. We want to celebrate tall poppies.
(eg. community service, wrote a book, went into business)

How did you hear about the The Christchurch Experience 40th Anniversary 2012 call for registrations of interest?

Sharing your Information

We know you will want to contact other alumni and others will want to contact you. The following section ensures we can follow your instructions about how your information can be shared.

Sharing of contact information with others I agree my contact information can be supplied to others for reunion related purposes. Please keep my contact information private.

Employment History/Information I agree my employment history/informationcan be supplied to others for reunion related purposes. Please keep my employment history/information private.

Significant Achievements I agree my significant achievements can be supplied to others for reunion related purposes. Please keep my significant achievements private.

I agree that my name can be listed on the list of reunion participants which will be available on the reunion website.

Any other informationIs there any other information you wish to provide?

Some of our Alumni are hard to reach. Over the years, we have changed our names, gone to distant lands, or just lost touch. So touch base with your friends and check they know we are planning this reunion. If you know of someone who should be there, please make sure they are by passing on the news.

40th Anniversary Registration Form

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