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:

Receive your first year of membership at a rate of only $88 (Offer valid Now-June 30, 2022. Offer applies to all membership categories).
Please select the membership category that applies to you, so we may learn your affiliation to the University.

Regular membership:

	Faculty
	Regent
	Staff

Department membership:

Department

Affiliate membership:

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

Community membership:

	Alumni
	Business
	Donor
	Parent

Wedding membership:

Wedding

Emeriti, Retired, and Surviving partner membership:

Faculty

Staff

Date of Wedding:

UMAA membership*:

UMAA Member

*UMAA Members that become a Campus Club Member receive 2 free months of membership to the Campus Club.

Student membership:

Regular membership ($88/year)

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 a billing option for University employees only. By choosing this option you are agreeing to continue your membership until you advise the Club otherwise.

Dues payments:

	10 month appointment ($4.19 per pay period - University ID # is Required)
	12 month appointment ($3.38 per pay period - University ID # is Required)
	9 month appointment ($4.63 per pay period - University ID # is Required)
	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 ):

Department Card Use Policy:

Your account number will be shared with you via email and you will receive two membership cards with this number. These cards are for department use only. We suggest that the department administrator, or other responsible person be in charge of the cards and the card number, and keep track of who is using the Club and for what purpose.

LUNCH is served Monday through Friday starting at 11am. We are happy to make guest cards for your group and reserve a table for them. To make a reservation call 612-626-7788 or email this form. BAR use is determined by your department. To make a reservation in the bar, call 612-624-9136 or email this form.

MEETINGS and EVENTS can be arranged through the events office by emailing ccevents@umn.edu. DEPARTMENTAL USE FORMS can help you to document department use of the Club. This form is available online or next to the cashier in the Servery.

PERSONAL USE of the department membership is not allowed. The membership is a University asset and therefore must be used for business purposes only. You may not give the department membership number to the cashier and pay with cash. You must charge to the account, or pay with a University P Card.

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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