Summer II 2013 – Summer I 2014 (June 27, 2013 - June 25, 2014) $270.00 (you only pay taxes)
Membership begins on the first semester day based on the University calendar.
New Renewal
Faculty Staff
Your name:
Address:
City: State: Zip:
University department:
Home phone: Work phone:
E-mail address:
Referred by:
Yes No I have read and understand all information in the SRC Membership Contract.
IMPORTANT TAX INFORMATION I hereby authorize the payroll department to deduct taxes from my paycheck. I understand this agreement is non-revocable and cannot be refunded for any reason. I understand that $270.00 will be reported as extra income and I will be taxed on this amount.
