Please note that you must be an alum, a faculty member, or a former faculty member of Harvard University to become a member of HUMA. Spouses of Harvard faculty and alums may also apply for membership.

We prefer that you submit this document along with your dues electronically using this website. If you would rather fill out a paper copy and mail it in, please download and print this document, which includes instructions and the application itself. If you have troubles with this file, please email Sara Hashmi, the Vice President of Internal Affairs.

I. Personal Information

Title	- Dr. Ms. Mr.
First name
Middle Initial
Last name
Gender	- Female Male
Date of birth	month - Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec day - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 year

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II. Harvard Affiliation

Check all of the following boxes that are applicable, and complete the appropriate sections (A, B, or C) below:

Alumnus/alumna Faculty Spouse of faculty or alum

A. Complete this section only if you are an alumnus/alumna.

School	- Divinity School Graduate School of Arts and Sciences Graduate School of Business Administration Graduate School of Design Graduate School of Education Extension School Harvard College Kennedy School of Government Law School Medical School Radcliffe College School of Dental Medicine School of Public Health Other
Degree
Year of graduation

If you have additional degrees from Harvard, please enter them into the “comments” section at the end of this application.

B. Complete this section only if you are a current or former faculty member.

School

- Divinity School Graduate School of Arts and Sciences Graduate School of Business Administration Graduate School of Design Graduate School of Education Extension School Harvard College Kennedy School of Government Law School Medical School School of Dental Medicine School of Public Health Other

C. Complete this section only if you are the spouse of an alum or faculty member.

Spouse’s name
Spouse’s school	- Divinity School Graduate School of Arts and Sciences Graduate School of Business Administration Graduate School of Design Graduate School of Education Extension School Harvard College Kennedy School of Government Law School Medical School School of Dental Medicine School of Public Health Other
Spouse’s year of graduation

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III. Contact Information

Address

Address 2

City

State/province

Zip/postal code

Country

Daytime phone

Evening phone

Permanent email address (please use post.harvard address if possible)

Check here if you do not want to be added to the HUMA discussion list-serve (1-2 emails/week)

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IV. Additional Comments

Please use this section to let us know about any HUMA projects that you are interested in working on, additional degrees you received from Harvard, etc.