Payroll Deduction Form for University Club Membership

IN ORDER TO ACTIVATE YOUR MEMBERSHIP, PLEASE CONTACT THE UNIVERSITY CLUB AND TELL THEM YOU ARE USING PAYROLL DEDUCTION.

Enter your name:



Enter your email address:

A family membership will deduct $12.50 per for a total payment of $75 or a single membership will deduct $9.17 for a total payment of $55.

The monthly deductions will begin on November 1 for 6 monthly payments of $12.50 for a family membership and 6 monthly payments of $9.17 for a single membership.

Please indicate if you are requesting a family membership or a single membership:

Family Membership              Single Membership.

Please enter your IU phone number:

Please enter your Employee ID Number