Alumni membership application

Fill out the following form:

Alumnus name

Title

Street address

Town/City

Postal code

Telephone

Cellphone

E-mail

Year affiliated with us

I was involved in...

Other information

Alumnus birthdate

Favourite quote

Favourite memory of Conquest

Occupation

Company

Type of business

Are you studying?

Yes
No

Name of institute

Course/Degree

What are you interested in?

Do you have any ideas?

Full Year (R500)
Lifetime (R1500)

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