Full Ordinary Membership Application Form

Full Ordinary Membership has a subscription of $475 annually. For other members click here.

Salary Deduction and Direct Debit forms:

Salary Deduction form (not required for new staff applications)
Direct Debit form

Membership Type*

Your Name*

Date of Birth

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

Residential Address*

Phone Number*

Please Specify at least one

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Mobile

Email Address*

Campus

Date you commenced working at The University of Melbourne*

Staff number*

Department/Institution at the University of Melbourne*

Job Title/Position*

How did you hear about the Club?

Have you visited University House before?

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After my first free 12 months, I authorise UoM Payroll Services to deduct from my salary my subscription to University House. I understand that the annual subscription will be deducted in fortnightly instalments of $18.30, after my initial free year.

I understand that I must notify the Member Services team at University House if I wish to suspend or cancel my membership after the first free 12 months.

Please leave this field empty.