LIFE MEMBERSHIP APPLICATION FORM
(Please complete using capital letters)
Mr/Mrs/Miss/Dr/Other______________________
Surname_____________________________________________
Other Names (include all) _______________________________
(Maiden Name_________________________________________)
Permanent Address___________________________________________________
___________________________________________________________________
Postcode________________________ Email__________________________________________
PLEASE COMPLETE RELEVANT SECTION:
Department________________________________________________
Graduate Yes Year of Graduation_____________
Staff Yes Staff No ______________________
Signature________________________________Date__________________________
Subscription fee for life membership £20
Application form & cheque (payable to AU Old Students’ Association) to be sent to The Honorary Secretary,
Development & Alumni Relations (DARO), Cledwyn Building, Penglais, Aberystwyth SY23 3DD
Alternatively you can email the application form to osaadmin@aber.ac.uk and pay directly to our bank account
sorting code: 40-08-09 account number 00829684 or, if overseas IBAN:- GB37 MIDL 4008 0900 8296 84 quoting
your full name as reference.
OSA membership data is held within the AU DARO alumni database under a formal agreement between the OSA and
Aberystwyth University. This personal data is retained and processed on the basis of your consent (Art.6(1)a) GDPR),
in accordance with current data protection legislation and in line with the both the AU Data Protection Policy and
DARO’s specific Data Protection Statement: www.aber.ac.uk/en/development/data-protection
https://www.aber.ac.uk/en/infocompliance/policies/dp
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