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Personal Details

Title

Honours

Surname (Required)

Surname when at SGHMS/SGUL (Required)

Forenames (Required)

Marital Status

Date of Birth

Address (including postcode) (Required)

Home Telephone

Daytime Telephone

Mobile Telephone

E-mail Address

Education

Entry Year at SGHMS/SGUL (Required)

Leaving Year (Required)

Course (Required)

Pre-Clinical School if not St George's

Placements at St George's and Partner Institutions (if applicable)

Other qualifications at SGHMS

Positions of responsibility/Membership of clubs at SGHMS/SGUL

Qualifications gained elsewhere with dates

Employment

Current Employment Status

Current Post (if applicable)

Income Per Annum

Previous Employments (with dates)

Professional Memberships

Directorships

Date of Retirement (if applicable)

Others

Personal Interest

Any attendance at, or organisation of, reunions since leaving (formal or informal)

We would like to know what kind of potential services from the Alumni Office would interest you. Please tick boxes accordingly where 5 indicates a strong interest and 1 indicates no interest.

Please tick boxes accordingly where 5 indicates a strong interest and 1 indicates no interest.

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Magazine
Info for Alumni on the Web
Events
Conferences and CPD
Sports Reunion
Discount Deals
Merchandise
Library Use
Sports Facility Use
Recruitment and Mentoring

Other Suggestions for Alumni Activity

If you reside with another graduate of SGHMS/SGUL or know someone else with an interest in St George's who would like to receive information in their own right please give details below.

Name

Address

IMPORTANT DATA PROTECTION DECLARATION

Data protection laws have recently changed in accordance with EC legislation.

All information on this form will remain confidential to St George's Alumni Association in accordance with the Data Protection Act 1988. The data will only be available to the office and to agents contracted by them for specific membership related purposes such as the circulation of the magazine and other school publications, notification of events and information on alumni benefits and special offers. Data might also be used at some future time to give you information about developments at St George's and the opportunity to offer financial support.

Under the terms of the data protection act we are obliged to obtain your agreement to the use of your data for these purposes.

I agree to the use of my data for all the above purposes.

Sections

Personal Details

Education

Employment

Others

IMPORTANT DATA PROTECTION DECLARATION