Member Information

Name*

First

Last

Affiliation

Alumnus

Current Student/Staff

Parent

Friend

Supporter

Sponsor

Graduated/Final Class Year*

Date of Birth*

mm/dd/yyyy

Spouse Information

Name

First

Last

Are you paying for your spouse to join Alumni Association?*

Yes

No

Not Applicable

Spouse Date of Birth

mm/dd/yyyy

Is your spouse an Alumnus?

Yes

No

Year Graduated/Final Year (Spouse)

Spouse Maiden Name

Contact Information

Home/Cell/Work Phone Number*

Email*

Membership Information

Choose one of the membership types below.

Alumni Annual Dues*

R250 - Individual

R500 - Alumnus and Spouse

Additional Donation to Alumni Association(This can be given monthly or once-off)

R50

R500

R1000

Other

Click here for the Banking Details

Declaration*

I hereby confirm that above information is correct. To keep my commitment to the monthly dues, I will instruct my bank to debit my account as per above selection. Use your name and surname as reference.

Upon verification of an alumnus and confirmation of payment received, we will issue a certificate of membership to you via email.

Alumni Membership Application Form

Make your #Pledge4Eternity

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