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Membership Application

To join the Stanford Faculty Club community, please complete the form below.

Please allow five business days for processing, at which time we will notify you of your approval for membership or of your ineligibility for membership.

Contact Information

Last Name:

First Name:

M.I:

Spouse's Name:

Title at Stanford:

Department affiliation (if applicable):

Stanford University Address:

Stanford Mail Code:

Home Address:

Send monthly bill to:

Home

Office

City:

State:

Zip:

Home Phone:

Stanford Phone (if applicable):

Email Address:

Additional Information

Please Check one of the Below Boxes:

Faculty, Academic Staff, University Staff – Other Teaching, Exempt Staff
(Paid 50% or more by Stanford & Benefits – Eligible)

Term Expiration Date:

Retirees:

Retired Faculty or Exempt Staff

Surviving spouse of a faculty or exempt staff member

Name of Former Member:

Current member of the Board of Trustees

Term Expiration Date:

Other Relationship with University (Please explain):

Alumni – Year:

Please Check one of the Boxes:

I am a Professoriate Asst. Prof. whose dues are waived by a Board decision

Retirees:

I agree to pay my dues annually in September

Faculty, Academic Staff, University Staff – Other Teaching, Exempt Staff:

I agree to pay my dues monthly by payroll deduction

Stanford ID#:

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