Where the University Community Meets

Campus Club Membership Form

Please complete and submit the form. Leave blank any fields that do not apply to you. You will receive a confirmation email when we have processed your application. If you have any questions, please call Ann Holt, Executive Director at 612-624-6626.

First name: *

Last name: *

Date of birth: *

Department:

College or Unit:

Title:

University start date:

Home address: *

City: *

State / Province / Region: *

Postal / Zip code: *

Work address:

City:

State / Province / Region:

Postal / Zip code:

Best Email address : *

Best non-work phone number ( + area code): *

Referred By:

Affiliate membership $228.50/year:

Visiting/Adjunct/Non-regular Faculty/Staff/Event Sponsor

Community membership $300/year:

	Alumni
	Business
	Donor
	Parent

Wedding membership $228.50/year:

Wedding

Date of Wedding:

U of M alumni association member:

Outside 11 county metro area: $228.50/year ($71.50 discount off normal alumni rate of $300)

Within 11 county metro area: $260/year ($40 discount off normal alumni rate of $300)

Alumni association member #:

Emeriti, Retired, and Surviving partner $120/year:

Faculty

Staff

U of M retirees association member or OLLI member $96/year (Payable quarterly):

	Faculty
	Other
	Staff

Student discount membership* $50/year:

Student

*Students are eligible for a special $50 membership. Club members at this level may not carry balances on their accounts and may not reserve rooms.

Payroll deduction is a billing option for University employees only. The first six months are free. By choosing this option you are agreeing to continue your membership and pay the second six months using payroll deduction and continue your membership until you advise the Club otherwise.

Dues payments:

	10 month appointment ($10.88 per pay period)
	12 month appointment ($8.79 per pay period)
	9 month appointment ($12.03 per pay period)
	Credit Card Option. Call 612-626-1510 or charge at the Club
	I will mail a check.

University ID # - Required for payroll deduction:

Please make a second card for my spouse/partner ( no extra charge ):

I hereby apply for membership in The Campus Club. I agree to pay the dues and charges I incur. I understand that all charges for Club services are due within 30 days. I certify that I have read the Personal Membership Polices and accept its terms. *

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Campus Club Membership Form

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