Student Membership Application

Candidate Information
Prefix:*
First Name (required):*
Last Name (required):*
Current Harvard School & Expected Graduation Year (degree programs eligible only):*
Undergraduate School & Degree Year (if applicable) :
Harvard ID# :*
Date of Birth (required):*
MM slash DD slash YYYY

Use Calendar or Format as: mm/dd/yyyy
Permanent Email:*
Enter Email Confirm Email
Cell Phone:*
Permanent Address:*
Address Line 1 Apt. # - Address Line 2 City State (abbreviated) / Province / Region ZIP / Postal Code Country
Business Phone:
Harvard Address (if applicable):
Address Line 1 Address Line 2 City State (abbreviated) / Province / Region ZIP / Postal Code Country
Please list date you expect to sign up (May 29 or later)
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.
Please Verify:
Phone
This field is for validation purposes and should be left unchanged.

Candidate Information