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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.
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* Surname
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HONS |
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e.g. OBE, AC, AO |
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* Given Name
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* School |
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* Degree |
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e.g. MBA, LLM, MPA, AMP,
AB |
* Title |
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(Prof, Dr, Mr, Ms)
+ Initials
e.g. Dr J S |
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Email |
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*
Year |
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Home Address |
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Work Address |
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* Address A |
e.g.
2 Smith Street Level 3
(not Lvl 3, 2 Smith St) |
Position
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Address B |
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Company
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* City/Suburb
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Address A
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* State |
NSW,
Vic, Qld, ACT, Tas, SA, WA, NT |
Address B |
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* Postcode |
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City/Suburb
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* Country |
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State
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* Phone |
e.g.
02 1234 5678 |
Postcode
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| Fax
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Country
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| Mobile
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e.g.
0418 123 456 |
Phone
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* Age Group |
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Fax |
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* Gender |
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* Where to send
Mail |
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* Occupation
Interest A |
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Name Spouse/Partner
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Notes (include here errors/omissions
in fixed data fields) |
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Note: Club's
Privacy Policy: Only Members with a username and password can view your
details.
Your choice "Where to send mail" will also control the address other
members can view.
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