Cincinnati Faculty Club
Membership Application
Name
First
Middle
Last
Mailing Address
Street Address
City
State
Zip
Phone
Format: (XXX) XXX-XXXX
Spouse's Name
E-mail Address
UC Employee
Yes
No
If so, UC ID Number
Department
Department Phone
Format: XXX-XXXX
Type of Membership
Regular $120 (UC employee)
Associate $60 (not available to UC employees)
Alumni
McMicken
Institute for Lifetime Education
UCAT/CClub
Deptartmental $240
Additional Card for spouse or departmental personnel
Method of Payment
Dues
Monthly UC Payroll Deduction
Annual Billing
Charges
Payroll Deduction (using employee ID badge)
Bill by Aramark to above address
E-statement (to above email address)
Monthly billing to those without email
Note: Cash, checks, credit cards (Visa and MasterCard) or Bearcat cards can be used on a pay-as-you go basis.
Birth Date (optional)
Format: MM-DD-YYYY
(For those who want to participate in the free lunch club)