Membership of Cornell Club of Hong Kong

Membership Application Form

Cornell University 6-digit ID

Leave it blank if you forgot your Cornell University ID number, we will assign you a temporary login ID.

Name*:

Salutation

First Name

Last Name

Maiden Name:

Home Address*:

Home Country*:

Home Phone No.:

Home Fax No.:

Home Email**:

Mobile No.:

Company Name:

Title/Position:

Company Address:

Company Country:

Company Phone No.:

Company Fax No.:

Company Email**:

Cornell 1^st Degree*:

School*:

Year*:

Cornell 2^nd Degree:

School:

Year:

Preferred Mailing Address:	Home	Business
Preferred Emailing Address:	Home	Business

Information to Publish to other Cornell Club of Hong Kong members:

	Home Address		Company Address
	Home Phone No.		Company Phone No.
	Home Email Address		Company Email Address
	Home Fax No.		Company Fax No.
			Company Name and Tile/Position

* Mandatory
** Must enter either one