Alumni at Queen Mary, University of London

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Title:
Forename(s):
Surname:
Address:
email:
Job title:
Organisation (if applicable):
Are you a former student of Queen Mary, Westfield, Barts or The London?	Yes: No :
If yes, please give details (College, subject and year or graduation:
Do you have any links with the College, i.e are you a former member of staff?	Yes: No :
If yes, please give details:
Full name of student:
Their department of study:
Your relationship to student:
Please tick the publication(s) you would like to receive: Queen Mary Annual Review QM (twice yearly) Advice and Information for Parents (once a year) Queen Mary Events Leaflet (three times a year) Barts and The London Chronicle (twice yearly) QUAD (twice yearly) QM Alumni e-Newsletter (once a term by email)
The information gathered on this form will be used for the purpose of providing services and information that may be of interest to you as a friend of the College, including the Queen Mary Family Programme, College events and appeals. If you do not wish to receive such correspondence from us, please tick here

Queen Mary, University of London, Mile End Road, London E1 4NS, Tel: +44 (0)20 7882 5555