Resident Membership Application Reservation number* SECTION A: Applicant DetailsName* Mr.Mrs.MissMs.Dr.Prof.Rev. Title First Last Date of Birth* DD slash MM slash YYYY Email* Second Email Telephone (Business)*Include country and area codesTelephone (Home)*Include country and area codesTelephone (Mobile)*Include country and area codesAddress for Correspondence* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home, postal or business address for direct mailSECTION B: Resident MembershipMembership of our prestigious 101 year old international collegium of graduates entitles you to reside in our Melbourne college and use our facilities. Membership is discounted for residents who are enrolled in a course of post-graduate study. The first membership fee includes a Joining Fee. Resident Membership entitles you to free or reduced fee participation in the GU Collegiate events shown in Section Q.Joining Fee Price: Resident Membership Price: SECTION C: Reservation (Booking) for ResidencyArrival Date Day Month Year Departure Date Day Month Year Number of people*Room Type* Residency Fee per Week* Comments Advance Payment of Residency Fee* Price: Minimum two weeks when booked term of residency > 2 weeksRoom Bond Transferred from previous booking. Refundable within 14 days of departure date (subject to terms). Two Weeks Residency Fee.Key Bond Transferred from previous booking. Refundable within 14 days of departure date (subject to terms). $50 each person.Car Park* Price: $10 daily or from $190 monthlyInternet Access* Price: SECTION D: Thank you for your donationThe Graduate Union is a charitable not for profit organisation established to support the advancement of education and wider public good. It holds Deductible Gift Recipient status. This means that your gift of A$2.00 or more is tax deductible. Please note that a donation is not a compulsory payment.Payment Amount for Donation TOTAL SECTION E: Purpose of Visit to Reside at the Graduate UnionPurpose* Study - enrolled for study Other Purpose - e.g., sabbatical, research, teaching, etc. University* Faculty* Department/School* Academic Contact name* Academic Contact email* Academic Contact phone* If enrolled for study, attach documentary evidence of enrolment (or letter of offer) to this application. Evidence of enrolment (or letter of offer)*Accepted file types: pdf, Max. file size: 64 MB.Please make sure you name your file as .Student Identification Number* Course code and name* Expected date of graduation MM slash DD slash YYYY Course datesYear 1Start Date* DD slash MM slash YYYY End Date* DD slash MM slash YYYY Year 2Start Date DD slash MM slash YYYY End Date DD slash MM slash YYYY Year 3Start Date DD slash MM slash YYYY End Date DD slash MM slash YYYY Purpose of visit* Letter of offer/invite*Accepted file types: pdf, Max. file size: 64 MB.Please make sure you name your file as .Staff or Visitor Identification Number SECTION F: The Graduate Union ScholarshipThe Graduate Union Scholarships are available to provide financial support to residents of The Graduate Union who are undertaking a research or coursework post-graduate degree. For more information on Awards and Opportunities, visit our Scholarships page.PaymentPayment Amount TOTAL $ 0.00 Payment Method* Bank Transfer Debit/Credit Card Account Name: The Graduate Union of the University of Melbourne Incorporated Bank: National Australia Bank BSB: 083 170 Account Number: 51561 2137 Swift Code: NATAAU3303M Name the transfer as your Surname and the word Resident Form. Please note that your application cannot be processed without receiving payment.Debit/Credit Card payments are provided by ‘Stripe’, a third party payment gateway. We do not store your credit card details, or have access to them.Credit Card*Card Details Cardholder Name The Graduate Union will confirm your Reservation within 14 days of receipt of payment.2018 Residential Agreement Terms and Conditions * I certify that the information provided by me, the applicant for residency, is correct, accurate and sufficient to enable The Graduate Union to serve reasonably my comfort and safety, and the comfort and safety of others during my residency. * I authorise The Graduate Union to consent to my receiving emergency medical or surgical treatment as may be deemed necessary, in the event that I am unable to communicate or The Graduate Union is unable to contact an immediate family member/emergency contact. * I authorise The Graduate Union to contact the emergency contacts listed in my record in the event of an emergency and as may be deemed necessary. * I confirm that I will notify The Graduate Union when any of the information changes, that I have provided in this Application Form before and during my term of residency. * I have read and agree to the Residential Agreement Terms and Conditions. * I hereby authorise The Graduate Union of The University of Melbourne Incorporated to settle any outstanding debts and penalty fees that I have not settled with cancellation of a confirmed reservation, with early departure from residency and/or prior to departure on my Reserved End Date. * I certify that I will not dispute settlement of outstanding debts and penalty fees that correspond to this Resident Membership Application Form and Residential Agreement Terms and Conditions with The Graduate Union of The University of Melbourne Incorporated. * I have read and understood the Privacy Policy shown at www.graduatehouse.com.au/membership/privacy-policy. * I commit to learn to state the 17 UN agreed 2030 Sustainable Development Goals www.undp.org/content/undp/en/home/librarypage/corporate/sustainable-development-goals-booklet.html * I hereby authorise The Graduate Union to use, reproduce, and publish photographs or videos that may pertain to me, including my image, likeness, or voice without compensation. I understand that this material may be used in various print and digital publications (The Graduate Union newsletter, Melbourne Graduate, Graduate House website and blog, and social media channels, and other marketing material relating to the Graduate Union and Graduate House). I understand that these materials may appear online or in print. This authorisation is continuous and may only be withdrawn by my specific rescission of this authorisation. * I agree to provide a signed copy of the Authorisation sheet within 48 hours of beginning my stay at The Graduate Union. CAPTCHAAccount Name: The Graduate Union of the University of Melbourne Incorporated Bank: National Australia Bank BSB: 083 170 Account Number: 51561 2137 Swift Code: NATAAU3303M Name the transfer as your Surname and the word Resident Form. Please note that your application cannot be processed without receiving payment.The Graduate Union will confirm your Reservation within 14 days of receipt of payment.NameThis field is for validation purposes and should be left unchanged.
