Alumni Association Membership and Contact Form

About You

Your Surname  

Your Forename  

Your Date of Birth  

Year -- 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 / Month -- January February March April May June July August September October November December / Day -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  

Your Name at Graduation (If different from current)

Your Student Number (If you still have this information)

Contact Address

Address Details  

Country  

Telephone Number (please include international dialling code)

Your Email Address  

Your Programme

Degree Awarded   Select your degree from the below: BA Management Studies BA Management Studies and Economics BA Management Studies with Politics BSc Human Resource Management MBA MSc Accounting and Finance MSc Finance MSc Human Resource Management and Training MSc Industrial Relations and Workplace Learning MSc Management MSc Management, Accounting and Finance MSc Marketing MSc Performance Management and Workplace Learning Masters by Research (MRes) Doctorate in Social Science PhD Diploma in Management Professional Diploma in Management Certificate in Management

Year Commenced Study  

Year of Graduation  

Mode of Study  

Campus-based full-time
Distance Learning

Current Employment Details

Employment Status  

Employed
Unemployed
Self-employed
Other:

(please specify)

Job Role

Name of Employer

Length of Time in Current Position

Under 6 months
6 months - 1 year
1 year - 3 years
3 years - 5 years
5 years and above

Main Sector/Industry Please select from the below: Agriculture, hunting and forestry Fishing Mining and quarrying Manufacturing Electricity, gas and water supply Construction Wholesale and retail trade; repair of motor vehicles, and personal and household goods Hotels and restaurants Transport, storage and communication Financial intermediation Real estate, renting and business activities Public administration and defence; complusory social security Education Health and social work Other community, social and personal service activities Private householdss with employed persons Extra-territorial organisations and bodies Other:

(please specify)

Data Protection Statement

Information supplied on this form will be stored and used in accordance with the Data Protection Act. It will be used for University purposes only, including; sending University publications, informing alumni of local events, fostering networking between alumni inter alia.

Authorisation   I hereby authorise the University of Leicester, and the University of Leicester School of Management to hold my personal details on a database of alumni. Please select:

Yes
No

Additional Authorisation   I further authorise them to make the personal information, contact details and current employment details I have given available to other alumni via a password protected website in the future:

Yes
No