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Authorisation to Collect Academic Regalia - Mackay

Only complete this form if you are registered to attend the
Mackay Graduation Ceremony on Friday 27 April 2012.

This form must be submitted by no later than 15 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: