Honorary Membership Application Form

Membership for Academic visitors to the University (short term) with a maximum of 28 days. UoM Honorary Fellows please apply for Associate membership. For other members click here.

Membership Type*

Your Name*

Date of Birth

Residential Address*

Phone Number*

Please Specify at least one

Home

Mobile

Email Address*

How did you hear about the Club?

Have you visited University House before?

YesNo

Please use your automatic response email as your approval access.