Membership Application Form

Name:  Campus or Home E-mail Address: 
Campus or Home Address:  Phone: 

Category of Membership (circle one)

Individual Membership $65 + $9.75 HST = $74.75/year ($2.88/pay period)

(open to full and part-time employees)

Family Membership $100 + $15 HST = $115/year ($4.43/pay period)

(open to families in which two persons are full- and /or part-time employees)

Name of other family member:
Phone:  E-mail: 

Associate Membership $25 + $3.75 HST = $28.75/year

(open to retired employees and their spouses, alumni, and friends of the University) 

Please register me as a member of the Club.
Signature:  Date: 

Annual Fee: $

Method of payment: (Circle one)
Cheque enclosed (Payable to the Memorial University Club)  Payroll deduction 

I hereby authorize the Department of Human Resources to deduct my membership fee bi-weekly by payroll deduction.
Signature:  Employee No.: 

The completed form should be sent to The Membership Secretary, Memorial University Club, Box 195, Arts and Administration Building, Memorial University, St. John's, NF A1C 5S7, or handed in at the Club

Club Telephone (709) 737-8328.