UCC Membership Registration

Fill out the following information, then pay us money.

Realname (First Last)
Username (lowercase)
Email Address
Phone Number
Student/Staff/DL Number
DOB (YYYY-MM-DD)

Gender:

Female:
Male:
Other:

Address:

Membership Type

Rejoining:
New Member:
Life Member:

Membership Type II

UWA Student, Guild
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UWA Staff, Guild
CASSA/ComSSA Member
None of the above

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