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Enrollment Form
Enrollment Form
Please fill out the following information below:

* Required fields
First name *

Last name *

Address *


City *

State * & Zip *

Country *

Phone *


Note: Our primary communications will be electronic via our web site and email. If you do not furnish us an email address, we will try our best to keep you up to date my mail (but that will be slower).

(Check one):
I am a member of the Harvard Business School class of 1963.
I am the Spouse/Significant other of a classmate that has joined Partners of '63.
I am the Widow (Widower) of a member of the Harvard Business School class of '63.

My level of interest is:
Member — no time commitment yet. My $630 contribution entitles me to receive full information on all Partners63 activities.

Partner — 10 days of time – or $10,000 in contribution – or a blend.

Senior Partner — 25 days of time – or $25,000 in contribution – or a blend.

Your annual membership is for the year ending December 31, 2002.

Make checks payable to "Partners of '63" and mail to us within the next few days. You will receive a "confirming letter" from our Treasurer for your tax files.

Our mailing address is:
Partners of '63
One Century Tower
265 Church Street, 16th Floor
New Haven, CT 06510

The Partners63 programs that I am most interested in are (check all of interest):
The New Teacher Project
Parents First
Public Education Leadership
Expeditionary Learning Schools
Innovations for Learning
Outward Bound
None as yet, but want to support Partners and participate

Any comments?

Any information you provide to the Partners of '63 will be treated in the strictest of confidence and used only by us.

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