Membership Application

Candidate Information

Prefix *

First Name *

Middle Name *

Last Name *

Suffix

Surname at Harvard, if applicable

Harvard Affiliation(s)/ School(s) *

Harvard degree type, month and year conferred *

Harvard Affiliation(s)/ School(s)

Harvard degree type, month and year conferred

Non Graduate Affiliation:

	Current Full-Time Harvard Faculty
	Former Harvard Faculty
	Fellow
	Board / Committee Member
	Officer

Non Graduate Affiliation Date(s) of Service:

Harvard ID# (if known):

Other Educational History

Undergraduate University/College *

Graduation Year *

Gender *

	Male
	Female
	Other

Date of Birth *

If Other

Membership Type (based on both home / work addresses): *

	Resident / Professional (NYC)
	Suburban
	Non-resident
	Current Harvard Faculty (Full Time)
	Joint (Current Member of The Harvard Club of Boston)

Click here, for more info on membership types

Primary Contact Information

Email *

Cell Phone *

Home Phone

By providing your phone number, you consent to receive text messages regarding club updates, events, and member notifications. Message and data rates may apply. You may opt out at any time.

Address Line 1 *

Apt. # - Address Line 2 *

City *

State (abbreviated) / Province / Region *

ZIP / Postal Code *

Country

Business Contact Information

Phone

Address Line 1 *

Apt. # - Address Line 2 *

City *

State (abbreviated) / Province / Region *

ZIP / Postal Code *

Country

Check All That Apply:

	Previously Applied for Membership
	Was A Former Member

Consent: By checking this box, I acknowledge I am applying for a membership and hereby sign/authorize the Welcoming Committee to make any necessary actions and inquiries to process this application. I also agree to abide by the Club's By-Laws and House Rules if I become a member and to pay when due all Club charges as invoiced to me. The “gift membership” is available only once per eligible new member and is not available to current or former members of the Club. Since our founding, the Club has been committed to promoting a spirit of fellowship among our members which reflects the spirit of Harvard University. Given this mission, the Club retains the absolute discretion not to admit applicants for membership. As a private club, we do not communicate about the basis for those admissions decisions.

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