Perth Modernian Society | Biographical Info Form

Biographical Information

Completing this form will help us keep in touch with recent graduates of Perth Modern School.
If you are an older graduate or staff member, please use this form instead.

* indicates required field

Family Name at School: *

Family Name now (if different):

Given Names: *

Nickname at PMS:

Email Address: *

Telephone Number:

Postal Address:

Year Attended PMS Year 7:

Year Attended PMS Year 8:

Year Attended PMS Year 9:

Year Attended PMS Year 10:

Year Attended PMS Year 11:

Year Attended PMS Year 12:

House:

PMS Highlights:

Primary School(s):

Secondary School (Other than PMS):

Current Activities:

Year of Birth:

Suburb/Town of Family Home during time at PMS:

Name of Person Providing This Information: *

Telephone Number:

Email Address:

Relationship to Ex-Student: *

Other family members who attended Mod (please include years):

If you are human, leave this field blank.