Application for UQ Alumni Membership
ABN 63 942 912 684
Fill out sections required, print and sign the form. Fields marked * are compulsory
Title (Mr,Mrs,Ms,Dr,etc.)
Last Name *
First Name and other initials *
Date of Birth *
As required by the Broadcasting Services Act
Home Address *
Email Address *
Phone No. * (At least one)
   Home     Work     Mobile  

Previous UQ Student Number
UQ Awards (eg. BSc, DipEd, MA) and year(s)
I graduated from UQ in    [year] with an award of   
I agree to abide by the Library Conditions of Use
I have read the list of services available to UQ Alumni and I am aware of my entitlements
Signature _________________________ Date _________________
Please hand the form in at:
any Branch Library
or
Fax: (07) 3365 6888
or		 Send to:
Circulation
Information Access Service
Duhig Building
The University of Queensland Library
St Lucia 4072
A library card will be mailed to you when the application is processed.
Fees 1 year $75 (GST incl.) or 6 months $50 (GST incl.)
Payment method  (fee must accompany application)   Payment amount:  
Cheque AUD$ Bank Draft       Payable to: The University of Queensland Library
Eftpos Visa Mastercard American Express
Cardholder Name
Cardholder Number
Expiry date



 
Library use only
Date received Receipt no. 
Expiry date28/02/Staff signature 
Barcode24067
Stat class 
Paid by    Eftpos      Cheque      Credit Card      Cash      Subsidy