Page 12 - HBS Newsletter 2019

First Name: ____________________________________________________ Last Name: ____________________________________________________
Company: ____________________________________________________ Class Year:_____________________________________________________
Billing Address: _________________________________________________ City, State, Zip: __________________________________________________
Phone: _________________________________________________________ E-Mail: _________________________________________________________
Payment: Visa MasterCard American Express Check (Made Payable to HBS Club of San Diego)
Card Number: ____________________________________________________ Name on Card: ___________________________________________________ Exp Date: ______________________ Security Code ___________________
Membership Level:
New Graduate ($0)
Regular Membership
CEO Forum Membership
HBS Friends' CEO Forum
Platinum Membership for Alumni
Platinum Membership Non Alumni $500 _____
2 YEARS $0
$125 $300 $400
1 YEAR $0
_____ _____
_____ _____
_____ _____
$75 $175 $225 $350
_____
_____
_____
$600 _____ $750 _____
Would you like your membership to auto renew? (Credit Card payments only) _______ YES _______ NO
Return your membership form via mail, email or pay online:
HBS Club of San Diego HBSClubSanDiego@gmail.com c/o The Henley Company
10598 Oakbend Drive www.HBSSanDiego.Org
San Diego, CA 92131
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