Spousal Membership Application

Candidate Information

Prefix: *

First Name *

Middle Name

Last Name

Your Harvard School/ Affiliation & Graduation Year *

Name of Spouse

Membership # of Spouse

Spouse’s Harvard Affiliation

Spouse’s Harvard Graduation / Affiliation Year

Your Non Graduate Affiliation

Faculty

Officer

Board/Committee Member

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

Marital Status

Married

Domestic Partner

Membership Information

Check all that apply to you

Previously Applied for membership.

Been a member of the Club.

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 *

City *

State (abbreviated) / Province / Region *

ZIP / Postal Code *

Country

Business Contact Information

Phone

Address Line 1

Address Line 2

City *

State (abbreviated) / Province / Region *

ZIP / Postal Code *

Country

Send Official Communication To: *

Primary

Business

Check All That Apply:

Previously Applied for Membership

Was A Former Member

By checking this box, I hereby sign and 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-Lacws and House Rules if I become a member and to pay when due all Club charges as invoiced to me. *

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Spousal Membership Application