Application for Lifetime Membership in the Old Scarborians Association

Please enter the information in the form below and press the Submit button

Only the fields with an asterisk on the right are mandatory. 
However, we would like as much information as you are willing to supply.

You will receive an acknowledgement and an invoice for your membership fee. 

  

Use the Tab key or the mouse to go from field to field. Except in the Comments area, the Enter key has the same effect as the Submit button.

If you omit a mandatory item, you will get an error message. To correct the error, just click on your browser's Back button and fill in the field that was indicated in the error message.

  
    
    
Title 
Surname  *
Forenames  *
Degrees/Qualifications 
Birth Date    Year   Month   Day 
   
Address 1  *
Address 2 
City/Town  *
County/State/Province  *
Post(al)/ZIP Code  *
Country 
   
Phone  *
Fax 
Email Address  *
  So that we can send you an acknowledgement,
please enter your email address carefully.
    
Year of Entry 
Year of Departure 
   
IMPORTANT! Data Protection Act, 1998, UK. The Old Scarborians Association will maintain the information you provide on this form in a database. The database is private and your personal information will not be made available (except as required by law), without your permission, to any other organisation or person.

Please click this box to acknowledge that you have read and understand the above statement. We cannot process your form unless you do.

   
Do you want an OSA tie?    Yes    Number of Ties  (Enter a number only if you select Yes.) 
    No 
  If Yes, you will receive the tie(s) and an invoice for £10, plus £10 per tie.
If No, you will receive an invoice for £10.
  
   
    Do not use the Enter key in the Comments field.
Comments   
    
   

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