Harvard Club of Australia       

 

Application Form
The following persons are eligible for membership
(1) Graduates of Harvard University.
(2) Other persons who have worked at Harvard University as members of one of the faculties.
(3) Other persons who have studied at Harvard University but not obtained a degree there from. Generally such studies will not be of less than six (6) weeks duration.

* Compulsory Fields. If empty type NIL.
 
* Surname    HONS  


e.g. OBE, AC, AO
* Given Name    * Title  


(Prof, Dr, Mr, Ms) + Initials
e.g. Dr J S
* School  
* Degree   * Year    
  e.g. MBA, LLM, MPA, AMP, AB        
       

     Home Address

    

          Work Address
* Address A   
e.g. 2 Smith Street Level 3 (not Lvl 3, 2 Smith St)		 * Position     
Address B    * Company     
* City/Suburb    * Address A     
* State   
NSW, Vic, Qld, ACT, Tas, SA, WA, NT		 Address B   
* Postcode    * City/Suburb   
* Country    * State   
* Phone   
e.g. 02 1234 5678		 * Postcode   
Fax    * Country   
Mobile    * Phone   
* Age Group      Fax   
* Gender     

* Email   

 

 

      
  * Where to send Mail   

 
* Occupation Interest A   
Name Spouse/Partner   
  Notes (include here errors/omissions   
 in fixed data fields)   

       
       
       



 
Note: The Club's privacy policy on the details available to other members is that your work address will be the default directory address and that the home address cannot be viewed by other members. Where there is no work address, members can decide what they would like to appear in the directory.