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 :
Home Address :
Street Address :
Address Line 2 :
City :
State / Province / Region :
Postal / Zip Code :
Country :
Work Address :
Street Address :
Address Line 2 :
City :
State / Province / Region :
Postal / Zip Code :
Country :
Work Address :
Best Email Address :
Best Non-Work Phone Number ( + area code) :
University Start Date :

Reqular Membership $217/year :
Introductory Membership for University Faculty and Staff and Student (First year half price!) $108.50/12 months :
Affiliate Membership $217/year :
Community Membership $300/year :
U of M Alumni Association Member $260/year :
Alumni Association Member # :
Emeriti, Retired, and Surviving Partner $120/year :
U of M Retirees Association Member or OLLI Member $96/year (payable quarterly) :
Student Discount Membership* $50/year :

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 the only billing option for this category. 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.

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 :
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