Burgmann College
- "the place to be!"

Update Personal Details
on Convocation Roll

To register or update your contact details, please complete as much of the following form as you can, and click on the [SUBMIT] button.

Family Name :
e.g. Smith
Given Name(s) :
e.g. John Michael
Name at College :
(nickname or maiden name)
Gender :
Date of Birth :
dd/mm/yyyy
Relationship
with College :
Years in College :
e.g. 1987,1988,1990
Institution Attended :
Course Studied :
e.g. BSc, BA(Hons), PhD
Email Address:
e.g. John.Smith@xyz.com
Web Address:
e.g. http://xyz.com/~jsmith
Postal Address :
Line 1:
Line 2:
City   :
State  :   Postcode:
Country :
Phone Number :
Can we publish
your contact details? :
e.g. in the web directory
Comments or
further information:
         

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December 9, 2000