Membership Application Form Membership Type* Full Ordinary MembershipFull Ordinary Membership - New University of Melbourne StaffAssociate MembershipAssociate Membership - PhD CandidatesTrial MembershipHonorary MembershipNon-Parkville Membership By completing a membership application form, you authorise and consent University Club 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 at www.unihouse.org.au. Copies are also available at Club Reception. Please indicate above which membership you are applying for: New University Staff - one year Full Ordinary (no voting rights) with subscription fee waived. PhD Candidates - Unrestricted Associate Membership with fee waived for the duration of their research (up to four years). Full Ordinary Membership - Subscription $450.00 annually Associate Membership - Subscription $300.00 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 For any membership queries, please call (03) 8344 5254, email membership@unihouse.org.au or come by Reception at University House, Professors’ Walk. Your Name* TitleProf.A/Prof.DrMsMrsMissMrOther Date of Birth Please fill out this field so that we may issue you with a birthday reward. Day12345678910111213141516171819202122232425262728293031 MonthJanFebMarAprMayJunJulAugSeptOctNovDec Year191719181919192019211922192319241925192619271928192919301930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017 Postal Address* Phone Number* Please Specify at least one Office Home Mobile Email Address* Campus Select OptionParkvilleSouthbankBurnleyCreswickDookieWerribeeShepparton 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
