Campus Club Membership Form

First name: *
Last name: *
Date of birth: *
Department:
College or Unit:
Title:
Home address: *
City: *
State / Province / Region: *
Postal / Zip code: *
Country: *
Work address:
City:
State / Province / Region:
Postal / Zip code:
Country:
Best Email address :
Best non-work phone number ( + area code):
University start date:
Birthday (Get a free dessert coupon during your birthday month):
Regular membership $224/year:
Introductory membership for university faculty and staff and student (First year half price!) $112/12 Months:
Affiliate membership $224/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:
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. *
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