Membership Application

Candidate Information

Prefix: *

First Name *

Middle Name

Last Name *

Suffix:

Surname at Harvard, (if applicable):

Your Harvard School/ Affiliation: *

Harvard Degree type, Year and Month conferred *

Your Harvard School/ Affiliation:

Harvard Degree type, Year and Month conferred

Your Non Graduate Affiliation (if applicable):

Current Full-Time Harvard Faculty

Former Harvard Faculty

Fellow

Board / Committee Member

Officer

Your Non Graduate Affiliation Date(s) of Service:

Your Harvard ID#:

Other Educational History

Undergraduate University/College *

Graduation Year *

Gender *

Male

Female

Other

Date of Birth *

Other Amount

Membership Information

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

Resident / Professional (NYC)

Tri-State

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 *

Address Line 2

Address Line 3

City *

State (abbreviated) / Province / Region *

ZIP / Postal Code *

Country

Business Contact Information

Phone

Address Line 1 *

Address Line 2

Address Line 3

City *

State (abbreviated) / Province / Region *

ZIP / Postal Code *

Country

Check All That Apply:

Previously Applied for Membership

Was A Former Member

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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Membership Application