CHECK - Membership Registration Form

2025-26 Membership Registration

$35.00 September 1, 2025 - August 31, 2026
If you are paying by CHECK, continue filling out this form.
If you are paying by PAYPAL, CREDIT CARD or DEBIT CARD fill out this form:

https://form.jotform.c1om/25154588713966
The information you provide will not be shared. It will only be used for Campus Club announcements and invitations.*

RenewalNew Member
If you are new to us, please let us know how you learned about Campus Club at Cornell
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityZip code

Postal / Zip Code
E-mail*
Do not use @twcny.rr.com
Phone Number*
Photos - Please let your Activity Group leader know if you don’t want to be in photos of your activity group.

If you are attending events open to all Club members, such as the Open House, Winter Social, and June Social, etc., please avoid being in the group photos if you don't want your photo on our website.
Liability waiver
By becoming a member of the Campus Club at Cornell (Club) I hereby agree to waive and hold harmless any liability against the Club, its Board and members and Cornell University for any bodily injury to myself or property damages I may incur, unless such injury or property damage results from the acts or omissions of the Club, its Board and members or Cornell University.
I agree with the Liability waiver above*

Yes
Date*

MonthDayYear
Date
Make the check payable to Campus Club at Cornell and mail the check to:

Campus Club at Cornell

PO Box 4821

Ithaca NY 14852
Enter check number and mailing date*

Check numberCheck mailing date
Please mail the check within 3 business days. Your membership is not active until we receive your check.
Should be Empty:

2025-26 Membership Registration

Liability waiver