Alumni Register

Forename:*
Surname (now) :*
Surname (at school) :*
Nickname (if applicable):*
Picture (optional):*
Sex:
Male
Female
Date of Birth :  /   / 

Current Address 1:
Current Address 2:
Current Address 3:
Country:

Oversea Permanent Address 1:
Oversea Permanent Address 2:
Oversea Permanent Address 3:
Country:

Leaving Year:*
Leaving Year Group :*  
Current occupation # :


Your first university name # :
Your first university course # :
Did you take any further degrees?: Yes No
If yes what is your highest level of education? # :
Verification:

(Please include here some information which will help us verify that you are a genuine Patana former student. This should include the names of at least two students who were in your tutor group/class, some of your teachers’ names and brief details of a school trip you went on.)


Email Address:

Alternative Email Address:

Are you happy for personal details marked with # to be shown on your profile?: Yes No
Show email address on your profile: Yes No
Receive communication from the school?: Yes No
Username:
Set Password:
(Please set a password at least six characters long.)

All items marked with an * will show on your profile