Register to be part of the ALUMNI

CENTRAL UNIVERSITY ALUMNI ASSOCIATION (CUAA)
MEMBERSHIP REGISTRATION FORM
ANY PERSON WHO STUDIED IN CUC FOR A MINIMUM OF ONE TRIMESTER/SEMESTER, QUALIFIES TO BE A MEMBER OF THE ASSOCIATION.
BY COMPLETING THIS FORM, YOU ARE HELPING TO BUILD A CREDIBLE ALUMNI DATABASE. * INDICATES REQUIRED FIELDS

CURRENT NAME (Block Letters):	*
JOB TITLE:	*
NAME AND ADDRESS of EMPLOYER:
PREFERRED CONTACT ADDRESS:
OFFICE TEL:
TEL (RESIDENCE):
MOBILE:
FAX:
EMAIL:	*
OFFICIAL NAME USED at CUC:
NICKNAME at CUC (IF ANY):
HALL of VIRTUE:
PROGRAMME UNDERTAKEN:	*
YEAR of ENTRY:	*
YEAR of GRADUATION:
DATE of APPLICATION: