MEMBERSHIP

To activate your Regent’s University Membership Card, complete and submit this form.

Our Membership Manager will contact you via email to confirm and validate your membership.

 

This information will only be used for our team to communicate with you and respond to your enquiry. Please check our Privacy Policy to see how we protect and manage your submitted data.

 

 

Please complete the form below

Name *
Name
Date of Birth *
Date of Birth
Address *
Address