Change of Details or Registration Form

Please use this web-form to update us with your current details. A hardcopy of this this form is available Alumni Change of Details Form (DOC 0.05 MB)

* required field

Your Details

Title:

*Surname:

*First names:

*Date of birth (dd/mm/yyyy):

Course attended/dept employed by:

Year you left LSHTM:

Home

Address:

Telephone:

*Email:

Business

Address:

Telephone:

Email:

Position:

How would you like to receive the annual alumni magazine?

Just electronically
By post and electronically

Would you like to receive further information about fundraising from our Development Office?

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For information about how your data may be used please refer to LSHTM Alumni Association Data Protection Statement.

• Change of Details or Registration
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• Contact us

• Alumni@lshtm.ac.uk

  T: (0)20 7636 8636

  F: (0)20 7636 8636

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