QMandWAlumni/Barts and The London Alumni Association Joining Form

*Required field

Personal details

Personal reference no.
(if known):

(eg. alpha numeric number beginning with a 'P' or 'M' above your name on your QUAD/BLC reply form)

Marital status:

First name(s):

Surname:

Title:

Other

Former name(s) (if applicable):

Date of birth (dd/mm/yy):

Address:

Post code:

Telephone:

Mobile:

Fax:

Email address:

Study details

First qualification:

College attended:

Graduation year:

Subject:

Second degree / Other qualification:

College attended:

Graduation year:

Subject:

Free subscriptions

Did you receive the latest copy of our alumni magazine?

QUAD BLC Not sure

Please include me in the online Web email Directory

Please send me OnQ, the newsletter for teachers and careers advisors

Please send me the Queen Mary Events leaflet

Please email me the monthly QM Alumni e-Newsletter

Employment profile

Your first destination - after graduation were you:

Employed
Seeking work
Self-employed
Further study
Retired
Volunteering
Other, please specify:

Job title:

Company:

Date (mm/yyyy) (from-to):

-

Please indicate your income band:
NB. This information will be treated in the strictest confidence and will not be disclosed.

Under £15,000
£15,000 - £19,000
£20,000 - £24,000
£25,000 - £29,000
£30,000 - £34,000
£35,000 - £59,000
£60,000 - £74,000
£75,000 - £99,000
£100,000 - £249,000
£250,000 - £490,000
Over £500,000

Current employment

Currently are you:

Employed
Seeking work
Self-employed
Further study
Retired
Volunteering
Other, please specify:

Name of current/recent employer (if self-employed, please give us details):

Occupation (eg. PR Officer):

Department:

Employment sector:
(eg. advertising, education):

Time in this employment:

Start date: End date:

Please indicate your income band:
NB. This information will be treated in the strictest confidence and will not be disclosed.

Under £15,000
£15,000 - £19,000
£20,000 - £24,000
£25,000 - £29,000
£30,000 - £34,000
£35,000 - £59,000
£60,000 - £74,000
£75,000 - £99,000
£100,000 - £249,000
£250,000 - £490,000
Over £500,000

Address of employer:

Post code:

Telephone:

Email address:

Employment website:

Other current work details (including voluntary work)

Organisation:

Title:

Start date (mm/yyyy):

Employment history

Company	Title	From (mm/yyyy)	To (mm/yyyy)

Can you offer to help Queen Mary?

Student placement	Careers advice
Graduate employment	Becoming a mentor
Research contracts	Organising a reunion
Student recruitment	Making a donation
Other, please specify:

Your news

We are pleased to receive your news for publication in the next issue of QUAD or BLC magazine (up to 60 words)

Please note that your news will be made available on our website.

Please tick this box if you do not wish your news to be published on the web.

Activities and support while a student

Name of scholarship/prize received (include year and amount please):

I was a Student Steward/Class representative:

I was a Student Ambassador:

I went on a student placement organised by:

Your network

Your family

Please give details of other Queen Mary, Westfield or Barts and The London School of Medicine and Dentistry alumni or current students to whom you are related. Please give their name, subject, college and year.

Your friends

We would like to know if you have stayed in touch with your contemporaries. Please give their names and subjects studied.

Lost friends

If you would like us to help you find lost friends from your College days please give as many details as possible, such as the subject they studied and years at the College. We will pass your contact details on to any individual(s) you name here.

Declaration

Under the terms of the Data Protection Act currently in force, your data is securely held in the Alumni Relations Office and is treated confidentially. The data is available to our faculties, academic Schools and administrative departments, and is used for a full range of alumni activities, including alumni relations mailings, the promotion of benefits and services available to alumni, notification of alumni events, networking and development and for feedback on the value of our courses. If you object to the use of your data for any of the above purposes, please contact the Alumni Relations Office at alumni@qmul.ac.uk .