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Harvard
Club of Australia
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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.
* Compulsory
Fields. If empty type NIL.
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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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* Title |
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(Prof, Dr, Mr, Ms)
+ Initials
e.g. Dr J S |
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* School |
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* Degree |
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*
Year |
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e.g. MBA, LLM, MPA, AMP,
AB |
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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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* Phone
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* Age Group |
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Fax |
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* Gender |
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*
Email |
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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: 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.
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