Membership Application Form

By completing a membership application form, you authorise and consent University House to collect, use and disclose personal information for the purposes of processing your application, administering your membership, providing services, and to contact you about other products, discounts and special offers in accordance with the Privacy and Data Protection Act 2014 (Vic). Our privacy policy can be viewed here.

For any membership queries, call (03) 8344 5254, email us, or visit reception at University House, Professors’ Walk.

Please indicate below which membership you are applying for:

New University Staff — one year Full Ordinary (no voting rights) with subscription fee waived.
PhD — Membership with fee waived for the duration of their research (up to four years).
Full Ordinary Membership — Subscription $450 annually.
Associate Membership — Subscription $300 annually.
Trial Membership — 28 days free subscription to enjoy Club’s facilities and events.
Honorary Membership — Visitors/Honorary/Short term, maximum 28 days.
Non-Parkville Campus membership — $225 pro rata.

Membership Type*

Your Name*

Date of Birth

Please fill out this field so that we may issue you with a birthday reward.

Postal Address*

Phone Number*Please Specify at least one

Office

Home

Mobile

Email Address*

Campus

Date you commenced working at The University of Melbourne*

Staff number

Student number

Date you conclude studies at The University of Melbourne

Department/Institution at the University of Melbourne*

Job Title/Position*

If Part Time, number of hours employed per week

Starting date of Membership*

How did you hear about the Club?

Have you visited University House before?

YesNo

Salary Deduction and Direct Debit forms