Membership

Application for FREE Life Membership

Application for FREE Life Membership

To apply for Life Membership in the Past Students' Union, kindly complete the online application form below. Once approved you will be contacted via e-mail with your username and password to access the secure members area of this site. Application is Free.

The membership form can also be downloaded here in Adobe Acrobat format and completed at your convenience. The completed form can then be e-mailed to us at membership@cicpsu.org or faxed to 1.868.623.0874 or delivered directly to the Past Students' Office at the College (1st Floor, Fr. Graf Wing).

* Required Field

Title *
First Name *	Last Name *
Nickname	Date of Birth*
Gender * Male Female
Home Address:
Street Address *	City *
Address Line 2	Country *
Occupation/Profession
Business Address:
Street Address	City
Address Line 2	Country

Contact Information
Home Number *	Mobile Number
Business Number	Fax Number
Email *
Postal Address:
Street Address	City
Address Line 2	Country

College Years
Year Entered College *	Year Left College *

Supplemental I have special skill/experience/interest in the following areas: ( You may enter up to 350 characters. ) characters left
I wish to serve on the committee(s) indicated:
Fund Raising
Membership
Public Relations
Student & School Affairs