Non-Parkville Membership Application Form

Non-Parkville Membership (UoM staff at campuses other then Parkville). For other members click here.

Membership Type*

Your Name*

Date of Birth

Please fill out this field so that we may issue you with a birthday reward.

Residential Address*

Phone Number*

Please Specify at least one

Home

Mobile

Email Address*

Campus

Date you commenced working at The University of Melbourne*

Staff number

Department/Institution at the University of Melbourne*

Job Title/Position*

How did you hear about the Club?

Have you visited University House before?

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