* 1. Surname:

* 2. First name:

* 3. Which Society are you joining?

* 4. SHU ID:

* 5. Mobile number: (Please enter as 07890 123456)

* 6. SHU email address: (Please double check your spelling)

* 7. Term-time address:

* 8. Personal email address: (Please double check your spelling)

* 9. Home address:

* 10. Next of kin details:

* 11. PLEASE READ THE FOLLOWING TEXT CAREFULLY - It is the responsibility of the individual to inform the Society's Committee/Trip/Event organiser, of any relevant medical conditions the Union should be aware of which may affect your safe participation in the society activities.

I agree:

• to act in accordance with the above statement and within the code of practices that are relevant to the activities in which I will participate

• that the information in this form is correct to the best of my knowledge

* 12. PLEASE READ THE FOLLOWING TEXT CAREFULLY - Hallam Union are committed to maintaining your information to meet the requirements of the Data Protection Act (1998). Appropriate technical and organisational measures shall be taken against unauthorised or unlawful processing of personal data and against accidental loss, disclosure, destruction of, or damage to, personal data that you have provided. The information provided above must be accurate and up to date, and by completing this form you agree that the information provided may be used for the purpose of sending relevant information and promotions directly to you (this includes the Societies' newsletter). If you DO NOT wish to receive such information please tick the NO box below.

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