BRISBANE STATE HIGH ALUMNI:
Please complete the form below to register to be part of the BSHAlumni.  
MEMBERSHIP APPLICATION / CHANGE OF DETAILS FORM
 

 
TITLE:
  
   
SURNAME:
  
   
FIRST NAMES:
  
   
FORMER NAME:
  
   
ADDRESS:
  
Postcode:
  
   
PHONE:
 MOBILE:
   
EMAIL:
  
   
LAST CLASS AT BSHS (ie Senior or 12):
  
   
OCCUPATIONAL DETAILS: (This provides information for AMICUS and provides a source of expert advice in various fields)
  



PLEASE CHOOSE WHICH MEMBERSHIP YOU REQUIRE

 
TICK   COST
     
ONE YEAR MEMBERSHIP $15
     
MIDTERM MEMBERSHIP (5 YEARS) $50
     
LONG TERM MEMBERSHIP (10 YEARS) $90
     
LIFE MEMBERSHIP $250