Membership Form

Personal Details

First Name

Middle Name

Last Name

DOB

Gender

Photo

Nickname at the University/Preferred Name

What was your degree in 1994 at UCC ?

What was your Hall of Residence ?

Address

Employeement Details

Employment Status

Industry	Position	Job Title	Start Date	End Date

Qualification Details

Type	Title	Award Date	Institution

Family Details

Marital Status

Spouse

Children

Father

Mother

Next of Kin

Emergency Contact

Name

Phone

Relation

Signature

Date

Login Details

Username

Password

Please read the statement below and tick the box if you agree to the statement.

Here at UCC94 Association, we take the privacy of our members data seriously and will only use your personal information for association administration purposes and for communicating with you about your membership. Only the Secretary and Treasurer will be able to access your details. More information about how we look after your data will be publish to the portal as soon as practically possible.