The University Club of Victoria:/clubform

HOURS
LUNCH
Monday to Friday
11:30 am –2:00 pm
DINNER
Monday to Saturday
5:00 pm –8:00 pm
BAR / LOUNGE
Monday to Friday
11:30 am –10:00 pm
Saturday
5:00 pm –10:00 pm

UNIVERSITY CLUB MEMBERSHIP APPLICATION - REGULAR MEMBER (VOTING)

Salutation:

Dr.

Mr.

Mrs.

Ms.

Miss

Name:

Surname:

First Name:

Initial:

Membership

PEA

CUPE

Department

Campus Local

Campus Email Address

Home Adress

City,Province

Postal Code

Home Phone Number

Please note that your monthly statement and club events information will be sent via email.

Spouse/Partner Information

Surname if different from above:

First Name:

Do you permit signing authority for your spouse or partner?

Yes.

Billing Information

I hereby agree to pay the required annual dues. Annual dues and monthly charges will be paid by payroll.
I further hereby authorize:

Dues to be charged

Monthly

Yearly:

Payroll Number

How did you learn about membership with the University Club?

This undertaking shall remain in effect until such time as I cease to be a member in accordance
with the bylaws of the Club. (Please note that once month's written notice of resignation is required.) I undertake to inform the University Club office of any changes in the status of my contact information.

I AGREE TO THE ABOVE TERMS AND CONDITIONS