Form Designer

Student Membership Application

Candidate Information

Prefix: *

First Name *

Last Name

Current Harvard School & Expected Graduation Year (degree programs eligible only) *

Current Harvard School & Expected Graduation Year (degree programs eligible only)

Undergraduate School & Degree Year (if applicable)

Your Harvard ID#: *

Attach Image of Your Harvard Photo ID card *

Choose

Date of Birth *

Permanent 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.

Permanent Address *

Address Line 2

City

State (abbreviated) / Province / Region *

ZIP / Postal Code *

Country

Business Phone

Harvard Address (if applicable)

Address Line 2

City

State (abbreviated) / Province / Region

ZIP / Postal Code

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. *

Submit

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Form Designer

Student Membership Application