RUPERT HOUSE ALUMNI ASSOCIATION FORM

Current Surname
Surname when at Rupert House (nee) A value is required.
First name (s) A value is required.
Email address
(or email address of someone through whom we may contact you)
If possible please use a home email address rather than a school or college one which will expire.		 A value is required.Invalid format.
Date of birth
In format dd/mm/yy		 A value is required.Invalid format.
Address
(please use separate lines
for different address lines)
Year you think you started Rupert House Invalid format.Minimum number of characters not met.Exceeded maximum number of characters.The entered value is less than the minimum required.The entered value is greater than the maximum allowed.
Year you think you left Rupert House Invalid format.Minimum number of characters not met.Exceeded maximum number of characters.The entered value is less than the minimum required.The entered value is greater than the maximum allowed.
Were you a ..............
(you may tick more than one)

Pupil Please make a selection.

Member of Staff Please make a selection.

Parent Please make a selection.
Other relevant information (siblings eg)

A value is required.