Membership Application To the Club Secretary Membership Eligibility Requirements Step 1 of 2 0% Candidate InformationPrefix:*Mr.Mrs.Ms.MissDr.Prof.Adm.Amb.Capt.Col.Com.GenHon.Lt.RabbiRev.First Name (required):* Middle Name: Last Name (required):* Suffix: Surname at Harvard, if applicable: Harvard Affiliation(s)/ School(s) (required):* Degree Month and Year conferred (required) ** 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 HistoryUndergraduate University/College (required):* Graduation Year (required):* Gender (required):* Male Female Date of Birth (required):*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Use Calendar or Format as: mm/dd/yyyy Marital Status: Single Married Divorced Domestic Partner Membership InformationMembership Type (based on both home / work addresses):* Resident / Professional (NYC) Suburban Non-resident Current Faculty (Full Time) Click here, for more info on membership typesCheck all that apply to you: Current Member of The Harvard Club of Boston (Applicable to individual/full memberships only) Been a member of the Club. 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LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Send Official Communication To:* Primary Business Interested in learning more about Fitness Membership? Yes How did you hear about the Club? HCNY Member Harvard Alumni Association Attended a Club Event Email Social Media Was A Former Member Summer Student Membership Harvard Publication LinkedIn Other Would you like to apply now for Signing Privileges for your Spouse? Yes The annual fee for signing privileges is 50% of your original annual dues amount (discounts such as joint membership or 25-year member rates do not apply). TO THE HOUSE COMMITTEE: I wish to apply for signing privileges for my spouse or domestic partner. My spouse will have a separate account, but I assume full responsibility for the payment of my spouse/domestic partner’s annual dues and all usage fees to my spouse/domestic partner’s house account. I understand that this signing privilege account is contingent upon my account as a full member of HCNY. Spouse First Name* Spouse Last Name* Spouse Email Address* Spouse Date of Birth (required):* MM slash DD slash YYYY Format: mm/dd/yyyy Spouse Gender (required):* Male Female Spouse Phone* Spouse Address: Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country 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. Please Verify:PhoneThis field is for validation purposes and should be left unchanged.