Personal

* Title e.g. Mr/Miss/Mrs/Ms:

* First name:

Initials:

* Surname:

Surname you were known by (if different from above):

Telephone Details

* Telephone (work):

Telephone (home):

Telephone (mobile):

Fax:

Address Details

* Address 1:

Address 2:

Address 3:

* Town / City / Suburb:

County / State:

* Postcode:

* Country: --- Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo (DRC) Cook Islands Costa Rica Côte d'Ivoire Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Islas Malvinas) Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong SAR Hungary Iceland India Indonesia Iran Iraq Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic of Ireland Reunion Romania Russia Rwanda Samoa San Marino São Tomé and Príncipe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Viet Nam Virgin Islands Virgin Islands (British) Wallis and Futuna Yemen Zambia Zimbabwe Zurch

Is this your home address or work address

Your time with us

*First Employment Period

Year joined --- 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012    Year left --- 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012    Location --- Abu Dhabi Amsterdam Athens Bahrain Bangkok Beijing Brisbane Brussels Calgary Canberra Cape Town Dubai Durban Frankfurt Hamburg Hong Kong Jakarta Johannesburg London Melbourne Milan Montréal Moscow Munich Other Ottawa Paris Perth Piraeus Prague Québec Rome Shanghai Singapore Sydney Tokyo Toronto Warsaw

* Position:

* Team:

* Key Contacts:

Second Employment Period

Year joined --- 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012    Year left --- 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012    Location --- Abu Dhabi Amsterdam Athens Bahrain Bangkok Beijing Brisbane Brussels Calgary Canberra Cape Town Dubai Durban Frankfurt Hamburg Hong Kong Jakarta Johannesburg London Melbourne Milan Montréal Moscow Munich Other Ottawa Paris Perth Piraeus Prague Québec Rome Shanghai Singapore Sydney Tokyo Toronto Warsaw

Position:

Team:

Key Contacts:

Current Employment Details

* Employment StatusEmployed Retired Other

Job Title:

Department:

Company:

Other:

Email and login information

* Primary Email:

Your primary email address will be your username to access the alumni website.

* Password:

* Confirm:

Terms and conditions

In order to be able to provide the benefits described in this membership form, Norton Rose Group will store the information provided and use it to contact you from time to time at the addresses and/or telephone numbers provided. Agreeing that Norton Rose Group may contact you from time to time in relation to member benefits is a condition of subscription to the Norton Rose Group alumni service.

One of the benefits of the Norton Rose Group alumni programme is the sharing of your contact details on the Norton Rose Group alumni directory, both the online and paper versions, with all members of the programme and within Norton Rose Group worldwide.

If you wish to unsubscribe from the programme at any time you can do so online at nortonrose.com/alumni or by email to hannah.websper@nortonrose.com.

Norton Rose Group’s alumni directory includes personal contact information as provided by our alumni on our secure alumni website and we do not guarantee its accuracy. If it is inaccurate, or if you are unable to locate an alumnus through our directory, it is because the current information has not been made available to us. Any changes to personal contact information must be made by you via the website nortonrose.com/alumni or by contacting the communications department on +44 (0)20 7444 3365, or by email to hannah.websper@nortonrose.com.

Norton Rose LLP is registered in accordance with the Data Protection Act 1998.