Payroll Deduction Enrollment

Name*

First Last

UIN*

Department

Email*

Phone Number*

Please select your annual employment term*

9 Months
12 Months

Please select your current pay schedule*

Monthly ($37 per month)
Bi-weekly ($18.50 bi-weekly)
Monthly ($25 per month) *20 Entry Membership*
Bi-weekly ($12.50 bi-weekly) *20 Entry Membership*

Please check that you have read and understand the following*

If my annual employment term is 9 months I will pay the monthly fee directly to Treasury Services if I wish to receive member access during summer months.
The payroll deduction for Rec Center membership will occur at the pay cycle following submission of this payroll deduction form
Payroll deductions will continue until I notify the department of Recreational Sports via the Payroll Deduction Cancellation form that I wish to cancel this payroll deduction.
The Payroll Deduction Cancellation Form must be received on or before the 15th of each month to stop the next deduction. Any forms received after the 15th will not be effective until after the next pay cycle.

I hereby authorize the PVAMU Payroll Office to deduct a fee from my paycheck for a Recreational Sports membership. I understand that payroll deductions can only be cancelled via the Payroll Deduction Cancellation Form by the 15th of the month. I have read and agree to the terms of this payroll deduction form.*

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