Dining Membership

FACULTY/STAFF DINING MEMBERSHIP SIGN UP FORM

Name Telephone Number Personnel Number Email E Card Number Semester______

Cost  Meals Per Week Dining Meal Plans Per Semester Dollars (Monday – Sunday) One (Includes Dining Dollars) Included Below 30 Block Per Semester $150.00 $50 60 Block Per Semester $300.00 $75 175 Dining Dollars Per Semester $175.00 $175

Dining Membership Terms and Conditions  Your Dining Membership will be active starting Thursday, August 20 during lunch, and the final meal for the fall 2015 semester will be served Saturday, December 12. There will be no meal plan for the break between semesters. Your membership will end for the Fall semester and you will need to sign up again for the Spring.  Any employee of ESU may purchase a meal plan.  You are obligated to pay the meal plan fee each semester, through biweekly payroll deductions. Any questions about payroll deduction should be directed to the Payroll Office in Human Resource Management at [email protected].  Once enrolled, employees will not be able to cancel the plan until the next semester.  Your ID is required whenever you wish to enter Dansbury Commons or purchase food from any of our other locations on campus. Meals and ID cards are non-transferable and may not be used by any other person.  If you lose/misplace your ID or it becomes damaged and our computer system can no longer read the magnetic strip, you will be required to obtain a new ID from the Campus Card Center on the lower level of University Center.  Block Meals are non-refundable, non-transferable, and do not rollover to the next semester. Any block meals remaining on an account on the last day of the fall semester will be forfeited.  Dining Dollars are non-refundable, non-transferable, and do not rollover to the next academic year. Any Dining Dollar funds remaining on an account on the last day of the spring semester will be forfeited.  A meal equivalency is accepted at all retail locations. The meal equivalency amount is $4.79, and is only accepted on food made in-house. All bottled, prepackaged foods are dining dollar, cash, E$ or credit only.  Special dietary needs will require a meeting with ESU Dining Services. Please contact the ESU Dining Services Office at Dansbury Commons (570) 422-3200. By signing this form, you have read, understood, and agreed to the terms and conditions of your meal plan membership. Payroll deductions will begin on September 18, 2015 and will be deducted in 10 equal payments ending on the pay of January 22, 2016 for the FALL semester plan. Employees will need to re- enroll for the following semester.

Signature Date FACULTY/STAFF DINING MEMBERSHIP SIGN UP FORM