Alumni Update Form
Full Name (*)
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Home Address (*)
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City/Town (*)
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State (*)
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NT
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VIC
SA
WA
TAS
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Post Code
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Occupation (*)
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Residential Phone
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Business Phone (*)
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Sponsor Rotary Club and District (*)
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Host District and Country
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Team Leaders Name (if Team Member) (*)
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Type of Award (*)
Group Study Exchange Team Leader
Group Study Exchange Team Member
Ambassadorial Scholars
Rotary Peace and Conflict Studies Program
Rotary World Peace Fellowships
Rotary Volunteer Service
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Dates of Exchange
From (*)
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To (*)
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Are you a Rotarian? (*)
Yes
No
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If No, have you been invited to become a Rotarian? (*)
Yes
No
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Would you like to be invited? (*)
Yes
No
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Would you like to receive the Alumni Newsletter? (*)
Yes
No
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Email Address (*)
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Please tell us what you have been doing since your return
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Antispam
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