• Phone: 859-622-2200

Membership Update Form

Membership Number
What year did you join The University Club? (If unsure, give best estimate)
Are you any of the following? (Check all that apply)
Primary Member
Name*
Set Date
Phone Number*
Email Address*
Address*
Street
City
State
Zip
Country
Spouse, if applicable
Name
Set Date
Phone Number
Email Address
Set Date
Dependents, if applicable
Please list the name and birthdate of eahc dependent under the age of 26
Dependent 1
Name
Set Date
Dependent 2
Name
Set Date
Dependent 3
Name
Set Date
Dependent 4
Name
Set Date
Dependent 5
Name
Set Date
Dependent 6
Name
Set Date
Dependent 7
Name
Set Date
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The University Club is a place where you feel welcomed, where members come together and life-long friendships are formed.

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1510 Lexington Road |
Richmond, KY 40475
Phone: 859-622-2200

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