Combination Membership and Donation Form

This form facilitates payment of your annual membership dues PLUS donation(s) to the Harvard Book Prize and/or the Harvard Club of New Hampshire as a single transaction.

When entering the Contribution Amount, you will need to include AT LEAST the cost of the annual dues (currently $10.00). If you wish to make a donation to the Harvard Prize Book fund or to our club in general, ADD this amount to the annual dues when entering in the Contribution Amount. So, for example, if you wished to donate one prize book at $25.00, enter $35.00 in the Contribution Amount field. In the "Harvard Prize Book Donation" and "Club Donations," please enter the amount of your donation that you would like apportioned to each of these funds.

Please note: the Harvard Club of New Hampshire uses PayPal as its credit card processor. You do NOT need to have a PayPal account, though, in order to use this system. When you are transferred to PayPal to process your payment, simply click on the "Continue" link under "Don't have a PayPal account?" and use your credit card as normal. If you do have a PayPal account, you may login to your account as usual.

Member - $ 10.00
1 Year Membership in the Harvard Club of New Hampshire

Contribution Amount *	$
	I will send payment by check
Email Address *

Combination Membership/Donation Form

Harvard Prize Book Donation *	Please enter the amount of the above donation that you would like apportioned to the Harvard Book Prize fund.
Club Donation *	Please enter the amount of the above donation that you would like apportioned to the Harvard Club of New Hampshire
First Name *
Last Name *
Street Address (Primary) *
City (Primary) *
State (Primary) *
Postal Code (Primary) *
Phone (Primary) *
First Harvard School *
First Harvard School Year of Graduation *	Enter the year in which you graduated from the first school at Harvard which you attended.
First Harvard Degree Received *	Please enter the name of the degree received at the first school you attended at Harvard.
Second Harvard School	Please select from the drop-down the second school -- if any -- that you attended at Harvard.
Second Harvard School Year of Graduation	Enter the year in which you graduated from the second school at Harvard that you attended.
Second Harvard Degree Received	Please enter the name of the degree you received upon completion of your second school attended at Harvard.
Third Harvard School	Select the third school at Harvard that you attended from the drop-down list.
Third Harvard School Year of Graduation	Please enter the year in which you graduated from the third school at Harvard which you attended.
Third Harvard Degree Received	Please enter the name of the degree you received upon completion of your third school attended at Harvard.
Interested in Serving on Our Board?	Yes No If you are interested in serving on our board, which meets twice annually, and/or to help with Club programs and activities, please indicate your interest here.

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Combination Membership and Donation Form