OA Panel Registration Please fill in this form only if you have been requested to by a member of the Alumni, Development & Archive staff. Thank you. Pelican-2-Pelican | OA Panel Registration Your Name MrMrsMsMissDrProfRevLadyLordSirColGenMajLt Prefix First Last Last name at Ardingly (if different than the one you have now) HouseAberdeenBurgessCrosseHiltonMertensNealRhodesToynbeeWoodard BoysWoodard GirlsGibbsLeaLewingtonWarrenWoodlandsBulteelABCDEFGWhich house did you belong to OR most identify with?Leaving Year Email PhoneAddress Street Address Address Line 2 City County / State / 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 Will you be attending in person or virtually? In person Virtually If you require any access assistance, please specify: If you have any dietary restrictions, please specify: Use of your email address* Yes, that is fine No thank you We use panellist emails to communicate and facilitate planning between OA participants, Alumni & Development staff and those directly working on your Pelican-2-Pelican session. Please confirm whether or not you are happy for your email address to be visible to the other panellists in these communications. Photography and communications preferences* Yes, that is fine No thank you The Alumni & Development Office will take photos at this event. These images, in addition to marketing materials created for the panel, may be used to share news about this event and to publicise this or similar events in The Ardinian magazine, on our website and social media channels. Please confirm whether or not you are happy to be photographed at this event and participate in publicity.Would you like to keep in touch? Yes, I am happy to be contacted by email Yes, I am happy to be contacted by telephone We will add the Personal Information you have supplied to the Alumni & Development Office database so that you will hear about events, news, volunteering opportunities and fundraising activities. We are committed to protecting your Personal Information and being transparent about what data we hold, where it came from and how we use it. We will always respect a request by you to stop processing your Personal Information. You can read our full Data Protection Statement here.