…SERVING THE
UCSD COMMUNITY
DEPARTMENTAL MEMBERSHIP INFORMATION
Date:__________________________
Department:__________________________________ Mail Code: ___________________
Department Chair: ____________________________ Phone: ______________________
Account Contact: _____________________________ Title: _______________________
Mail Statements To:
Name:______________________________________ Mail Code:____________________
Fees and Dues:
Initiation
Fee = $ 0
Semi-annual
dues = $210.00
per account
Ongoing
dues will be recharged in January and July.
All departmental charges must be for official University business and
must be recharged to the department. No cash or credit cards can be
accepted. A detailed receipt will be given to the card holder
when service is provided. All charges
for dues, food and beverages (except
alcohol) will be RECHARGED to the fund/index you provide below (NO FEDERAL FUNDS).
Your monthly statement is a summary of all charges and payments.
Club charges are processed in accordance with the University sponsored entertainment policies
and procedures in PPM 350-30. Dues are
paid in accordance with PPM-350-50. You may fax this completed document to
(858) 534-5719.
Fund ______________________________ ______________________________
Index ______________________________ Authorizing
Signature (PPM350-7)
ORG ______________________________
______________________________
Program ___________________________ Authorizing Signature (PPM350-30)
UNIVERSITY OF
CALIFORNIA, SAN DIEGO
LA JOLLA,
CALIFORNIA 92093-0121
(858) 534-0876
(858) 534-5719
Fax