Online Application Membership Benefits Amenities & Services Online Application Membership Application TO THE SECRETARY OF THE ADMISSIONS COMMITTEE: Candidate Information Name Prefix: First Name (required): Middle Name: Last Name (required): Surname at Harvard, if applicable: Name Suffix: Harvard Affiliations(s)/School(s) (required): Graduation Year(s) (required): Non Graduate Affiliation: FacultyOfficerBoard/Committee Member Date(s) of Service: Harvard ID# (if known): Gender (required): MaleFemaleOther Date of Birth (required):   Format: mm/dd/yyyy Marital Status: SingleMarriedDivorcedWidowedOther Membership Information Membership Type: ResidentSuburbanNon-Resident Click here, for more info on membership types. Other Membership Category: Check all that apply to you: Previously Applied for membership.Been a member of the Club. Personal Contact Information Email (required): Phone (required):   Format: (212) 555-5555 or international formats Address (required): Address Line 2: Address Line 3: City (required): State:   State is required if country is USA. Zip Code /Postal Code (required): Country (required): Professional Contact Information Email: Phone:   Format: (212) 555-5555 or international formats Address Line 1: Address Line 2: Address Line 3: City: State: Zip Code /Postal Code: Country: Send Official Communication To: PersonalProfessional Other Educational History Undergraduate University/College (required): Graduation Year (required): Graduate/Post Graduate Program: Program Completion: Graduate/Post Graduate Program: Program Completion: In addition, the Club is always interested in knowing which communication methods our membership prefers. Which of the following methods do you normally use? Please check all that apply: MailE-MailWebsiteFacebook Other: Consent By checking this box, YOU hereby authorize the Admissions Committee to make any necessary inquiries to Harvard University to verify the information on this application.