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UW Club Membership Application
Application Form
Membership Information
Required
Surname
*
Required
First Name
*
Required
Title
Mr.
Ms.
Miss
Mrs.
Dr.
Professor
*
Required
University Department (if applicable)
*
Required
Address
*
Required
Postal Code
*
Required
Please enter a 10-digit phone number. You can use hyphens or periods to separate numerals, and you can put the area code in parenthesis.
Business Phone
*
Required
Please enter a 10-digit phone number. You can use hyphens or periods to separate numerals, and you can put the area code in parenthesis.
Personal Phone
*
Required
Please enter a valid email address with the format youraddress@yourdomain.
E-mail
*
Additional Information
Required
I have been a member of the University of Winnipeg Club before
Yes
No
*
Required
Were you referred by another member?
Yes
No
*
Required
Name of Member
*
Required
How did you hear about the Club?
*
Required
Would you be interested in volunteering?
Yes
No
*
Fee and Payment Information
Required
Payment method
Credit Card
Payroll
Complimentary
*
Required
Regular Member
Faculty $200.00 annual fee/ Payroll Deduction $8.34 per pay
Senior Admin $200.00 annual fee/ Payroll Deduction $8.34 per pay
Staff $100.00 annual fee/ Payroll Deduction $4.17 per pay
Members of the UW Retirees Association
Members’ spouses (who are not UW employees)
Off campus members of the Board of Regents
$40.00 Annual Fee
*
Required
If you are not a UW employee, please add your employer’s name
*
Required
(check all that apply)
Part Time Employee
Post-Doctoral
Graduate Student
Term Staff Employee
Member of PACE’s 55+ Program
Alumni
Other Post-secondary Institution
Enter your own value
*
This field is required.
This value is not unique.
*