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Authorisation to Collect Academic Regalia - Bundaberg

Only complete this form if you are registered to attend the
Bundaberg Graduation Ceremony on Thursday 19 April 2012.

This form must be submitted by no later than 5 April 2012.


All fields are required
Name:
Student Number:
Current Email Address:

I understand my delegate must provide identification.
I give permission for the following person to pick up my Academic Regalia on my behalf.

Delegate's Name: