Professional Staff Conference Membership Application University House is offering Club membership for 12 months, with subscription waived, to all Professional Staff Conference delegates. Gain access to Club venues and amenities (when we can re-open!), In-House and online Member events, exclusive member offers, and connect with member interest groups. To join simply complete and forward the form below. Should you have any questions regarding membership, you can contact our team by emailing membership@unihouse.org.au. By completing a membership application form, you authorise and consent University Club to collect, use and disclose personal information for the purposes of processing your application, administering your membership, providing services, and to contact you about other products, discounts and special offers in accordance with the Privacy and Data Protection Act 2014 (Vic). Your Name TitleProf.A/Prof.DrMsMrsMissMrOther Date of Birth Please fill out this field so that we may issue you with a birthday reward Day12345678910111213141516171819202122232425262728293031 MonthJanFebMarAprMayJunJulAugSeptOctNovDec Year19171918191919201921192219231924192519261927192819291930193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010 Postal Address* Phone Number* Please Specify at least one Office Home Mobile Email Address* Campus Select OptionParkvilleSouthbankBurnleyCreswickDookieWerribeeShepparton Date you commenced working at The University of Melbourne* Staff number Department/Institution at the University of Melbourne* Job Title/Position* If Part Time, number of hours employed per week