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:

Fall 2020 membership special $10 (Membership expires 12/31/2020. Credit card required and will be charged at time of order. Call 612-626-1510 or 612-624-6626 with card information and any questions):

	Faculty
	Staff
	Student

Affiliate membership $228.50/year:

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

Community membership $300/year:

	Alumni
	Donor
	Parent
	Business

Wedding membership $228.50/year:

Wedding

Date of Wedding:

U of M alumni association member:

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

Outside 11 county metro area: $228.50/year ($71.50 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
	Staff
	Other

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:

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

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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