IPC Alumni: New User Registration Form

1.   This form is only for students who graduated from IPC

2.   International Pacific College respects the privacy of individuals and strictly adheres to the Privacy Act.

3.   Please complete all details on this screen
The fields marked * are required, as this data will be checked against your records at IPC to ensure safety. The ID Number is your student number as appeared on your IPC Student ID Card.

Your Name at IPC:

Please type your name as it appears on your IPC degree or diploma:

First Name: *

Last Name: *

Student ID Number (if known, otherwise type 0): *
S

Title:
Mr Miss Mrs Ms Dr Title

Gender:
Male Female Gender

Your Current Name:

Please type your current legal name:

First Name:

Last Name:

Nationality: *
Select Your Nationality Afghan Albanian Algerian American Argentinean Armenian Australian Austrian Azerbaijan Bangladeshi Belarus Belgian Belize Bolivian Bosnian Brazilian British Bulgarian Burmese Burundian Cambodian Canadian Chilean Chinese Colombian Congolese Cook Islander Dutch Ecuadorian Egyptian Eritrean Ethiopian Fijian Filipino French French Polynesian Georgian German Greek Hungarian Indian Indo-Fijian Indonesian Iranian Iraqi Irish Israeli Japanese Jordanian Kenyan Khymer Kiribati Korean Kuwaiti Latvian Libyan Macedonian Macau Malagasy Malaysian Mauritian Mexican Mongolian Namibian Nepese Nepese Nepainese New Caledonian New Zealander Nigerian Pakistani Palestinian Papua New Guinean Peruvian Philipino Polish Portuguese Romanian Russian Rwandan Samoan Saudi Arabian Serbian Siberian Singaporean Somalian South African South Korean Spanish Sri Lankan Sudanese Swedish Swiss Syrian Tahitian Taiwanese Tajik Thai Tongan Turkish Tuvaluan Ugandan Ukrainian Uruguayan Uzbekistan Vietnamese Yugoslavian Zimbabwean

Current Title:
Mr Miss Mrs Ms Dr Title

Date of Birth: *
Date01020304050607080910111213141516171819202122232425262728293031 Month January February March April May June July August September October November December Year1940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000

Your Current Postal Address:

Please type your current postal address:

House Number:

Road/Street Name:

Town:

City:

Postcode:

Country: *
Select Country AlbaniaArgentinaArmeniaAustraliaAustriaAzerbaijanBahrainBelgiumBoliviaBosniaBrazilBulgariaCentral AmericaChileChinaColombiaCosta RicaCroatiaCyprusCzech RepublicDenmarkDominican RepublicEcuadorEgyptEstoniaFinlandFranceGermanyGreeceGuatemalaHondurasHong KongHungaryIcelandIndiaIndonesiaItalyJapanJordanKenyaKuwaitLatin AmericaLatviaLebanonLithuaniaLuxembourgMacedoniaMalaysiaMexicoNetherlandsNew ZealandNigeriaNorwayOmanPalestinePanamaPeruPharos IslandsPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaSalvadorSaudi ArabiaSerbia & MontenegroSingaporeSlovakiaSloveniaSouth KoreaSpainSwitzerlandSyriaTaiwanTanzaniaThailandTurkeyUAEUgandaUKUkraineUruguayUSAVenezuelaVietnamYugoslavia

Some General Information:

Please answer some questions about yourself, this data will be checked against your records at IPC to ensure safety and security. You may be contacted to provide more information, so please type your primary phone number.

Email Address:

Please type your primary email address. You must have a valid email address to use the IPC Online Directory, as your initial login information will be sent to this email address. If you do not have an email address, you can sign up for a free account with Hotmail, Yahoo! Mail, WebMail, or one of the many others.

Email Address: *

Re-type your Email Address: *

Choose a Password:

Please choose a password to use when your registration is approved. Password must be at least 6 characters in length. Your password will be encrypted for your security.

Password: *

Re-type your Password: *