PhD Membership Application Form

This is the membership application form for PhD students. For other members click here.

Membership Type*

Your Name*

Date of Birth

Residential address *

Phone Number*
Please Specify at least one

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UoM Student Email Address*

Student number*

Expected completion date*

Department/Institution at the University of Melbourne*

How did you hear about the Club?

Have you visited University House before?

YesNo

Your membership card will be available to collect from University House reception in the first week of the following month upon this application.