Registration Form Chemical & Biomolecular Engineering Alumni Wine Tasting



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Date06.02.2017
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Registration Form

Chemical & Biomolecular Engineering Alumni Wine Tasting

Friday 20 April 6pm – 8pm
The Chemical & Biomolecular Engineering Courtyard
RSVP Deadline: Wednesday 11 April 2012
Personal details

Alumni of the University of Sydney? (Includes all graduates of the Sydney Conservatorium of Music)

 Yes  No Degree & Graduation Year:



Title:  Mr  Ms  Mrs  Miss  Dr  Other _____________________

First name/s: Last Name:

Mailing Address:

City: State: Post Code: Country:

Contact Phone:  Home  Work  Mobile: (____) _____________ Contact Email:________________________

GUEST details

Dietary / Special Needs:

Names of Guests /Alumni Details (eg John Smith (BA ’75)):




BOOKING details
Please accept my payment of: _____ Alumni ticket/s $30.00 per person – incl. GST
_____ Guest ticket/s $30.00 per person – incl. GST
TOTAL $ __________

Payment details

 Cheque (make payable to The University of Sydney)
Credit Card:  Visa  MasterCard  American Express  Diners Club

Card No: Expiry Date: /

Cardholder Name: Signature:

Please mail back to: Karen Worsfold, Alumni Relations Officer, Faculty of Engineering & IT

Room 226, School of IT Building (J12), The University of Sydney NSW 2006



ABN: 15 211 513 464. CRICOS Number: 00026A.

Further details: T 02 9036 9760 F 02 9351 2111 E karen.worsfold@sydney.edu.au

sydney.edu.au/alumni/

PRIVACY ASSURANCE: The information you provide may be used to maintain contact and keep you up-to-date with information about the University, its services, events and achievements. It may be passed on to groups affiliated with the University, such as alumni organisations and foundations (local and overseas), SU Sport and residential colleges. Your name may be published in the annual honour roll. If you do not wish to receive this information, please contact Advancement Services (fax +61 2 8627 8819, or email alumni.updates@sydney.edu.au). The University of Sydney abides by the 'NSW Privacy and Personal Information Protection Act'.

OFFICE USE ONLY: 34302 51001 M4GCBTURN / ARO




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