Application for FREE Life Membership

To apply for Life Membership in the Past Students' Union, kindly complete the online application form below. Once approved you will be contacted via e-mail with your username and password to access the secure members area of this site. Application is Free.

The membership form can also be downloaded here in Adobe Acrobat format and completed at your convenience. The completed form can then be e-mailed to us at membership@cicpsu.org or faxed to 1.868.623.0874 or delivered directly to the Past Students' Office at the College (1st Floor, Fr. Graf Wing).

* required fields
Title:
   
First Name*:

 
Middle Name (if any):
 
Last Name*:
 

Date of Birth*:

Gender:
Male
Female
Email Address*:
 
   
Telephone Number (Mobile):
   
College Years*:

Year Entered

 

Year Left

Home Address:  
Street Address:
Address Line 2:
City:
Country:
Telephone Number (Home):
   
Occupation:  
 
   
Business Address:  
Street Address:
Address Line 2:
City:
Country:
Telephone Number (Business):
   
I have special skills/experience/interest in the following areas:
I wish to serve on the committee (s) indicated:

Fund Raising
Membership
Public Relations
Student & School Affairs