<p> THE FACULTY CLUB/COHEN HOUSE OF RICE UNIVERSITY – MS 52 P O BOX 1892  HOUSTON, TX 77251-1892 EMAIL [email protected]  Phone: (713)348-4000  URL: facultyclub . rice .edu</p><p>APPLICATION FOR MEMBERSHIP</p><p>RETURN COMPLETED SIGNED FORM TO MEMBERSHIP CHAIRMAN, FACULTY CLUB BOARD, COHEN HOUSE, RICE UNIVERSITY AND MAKE CHECK PAYABLE TO RICE UNIVERSITY</p><p>Please Print: Date </p><p>Name </p><p>Position Department MS </p><p>Business Address Zip Phone </p><p>Home Address Zip Phone </p><p>Email Address Employee/Student ID number </p><p>REPLACEMENT OF MEMBERSHIP CARD $10.00 </p><p> Issue additional Card for Spouse: $10.00 (Voting Members & Non-Voting Members only)</p><p>Spouse’s Name: </p><p>VOTING MEMBERS: $30.00 ONE-TIME INITIATION FEE  Full-time Professors, Associate Professors  Full-time Assistant Professors, Lecturers & Instructors  Professors Emeritus  Research Faculty  Retired Voting Members</p><p>NON-VOTING MEMBERS: $30.00 ONE-TIME INITIATION FEE  Benefits Eligible University Staff  Part-time Lecturers & Instructors  Board of Trustees  Executive Board of the Alumni Association  Past Presidents of the Executive Board of the Alumni Association  Rice University Associates  Retired Non Voting Members  Spouses of Deceased Voting Members  Spouses of Deceased Retired Members</p><p>Sponsored guest MEMBERS: $20.00 yearly membership dues  Visiting and Adjunct Professors (all ranks)  Non-Benefits Eligible University Staff  Special Department Associates  Postdoctoral Fellows  Graduate Students (full-time second year or later)  Continuing Education Instructors</p><p>Certified guest members: $20.00 yearly membership dues  Postdoctoral Fellows  Graduate Students (full-time and part-time)  Continuing Education Instructors I hereby authorize Rice University to deduct from my paycheck the entire amount of my Faculty Club bill, provided this authorization shall be effective only when at least part of this amount has been unpaid for 45 or more calendar days following the date of the statement in which the past-due amount was first included.</p><p>I understand if any part of my bill is unpaid 45 calendar days after the date of the statement including all charges to date, a 10% penalty fee will be added to my Faculty Club account balance before payroll deduction and/or cancellation of membership.</p><p>Required Signature </p><p>ALL APPLICATIONS MUST BE SIGNED BEFORE BEING PROCESSED. MAKE CHECK PAYABLE TO RICE UNIVERSITY Sponsored guest members:</p><p>Requires sponsorship from Department Chairperson or Dean.</p><p>Sponsoring Department is responsible if final payment is not received to clear guest members accounts.</p><p>Guest memberships are extended and renewed on a yearly basis by the Faculty Club Board solely for their individual use of the Faculty Club facilities.</p><p>Graduate Students – Card expires two weeks prior to commencement. Summer cards are issued to graduate students working on campus during the summer months with required sponsorship by the Department Chairman.</p><p>Continuing Education Instructors – Appointed by Rice University and at least two years of teaching at Rice is required. Summer cards extended on request with required sponsorship by the Department Dean.</p><p>Signed (Please print name) Department Chairperson or Dean</p><p>Certified guest members:</p><p>These guest members are certified by the Department Chairperson or Dean.</p><p>Must pay a $100.00 interest free refundable deposit.</p><p>Graduate Students – Card expires two weeks prior to commencement. Summer cards are issued to graduate students working on campus during the summer months with required sponsorship by the Department Chairman.</p><p>Continuing Education Instructors – Appointed by Rice University, certified by the Dean, and at least two years of teaching at Rice is required. Summer cards extended on request with required certification by the Dean.</p><p>Signed (Please print name) Department Chairperson or Dean</p><p>Do not write below this line</p><p>Approved Date </p><p>Disapproved Date </p>