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.
 
* Surname    HONS  


e.g. OBE, AC, AO

* Given Name       

 

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

     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   
e.g. 0418 123 456
Phone   
* Age Group      Fax   
* Gender     

  

 

  * Where to send Mail   

 

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

       
       
       



 

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