Coburg High School Historical Group, Inc.

Register of Former Students

Please supply the following information:

Is this a new submission, or are you updating data already submitted?
New Submission
Updating Data

Preferred Title:


Surname when at CHS:


Surname now (if different):


First Given Name:


Other Names:


First Year at CHS (e.g. 1956):


Final Year at CHS (e.g. 1962):


Level in Final Year (Select from drop-down menu):


Preferred Email Address:


Profession/Occupation  (If retired, please indicate your former occupation):


Current Postal Address (line 1):


Current Postal Address (line 2):


Current Postal Address (line 3):


Current Postcode:


Where did you live when you were at CHS? e.g. Coburg, Brunswick, Pascoe Vale:


Telephone:


Mobile Telephone:


Is there anything else that you would like to tell us?: