Campus Club Membership Form

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:
Fall Membership Drive Special* $88/first year (Ends Dec. 31 2019):
Date of Wedding:
Alumni association member #:
Student discount membership* $50/year:
University ID # - Required for payroll deduction:
Dues payments:
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. *
Today's date: