Somerset Point & Stilley Membership Program Enrollment

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First Name
Last Name
Gender
Employee Number
Mail Code
Street Address
City
State
Zip Code
Email Address
Phone Number
Work Extension

Eligible Dependents ?


       
Do you have a spouse?
       



Total
Payroll Deduction (26 Pay Periods)
 I acknowledge that I have read and agree to the membership guidelines.
 I acknowledge that I have read and agree to the following payroll deduction terms and conditions.

I hereby authorize Santee Cooper to deduct the above amount from my bi-weekly pay for an Annual Recreation membership. I understand this sum cannot be refunded. I represent that this authorization is executed voluntarily and has not been made as a condition of my continued employment.

I hereby authorize the payroll department to deduct the specified amount from my paycheck. I understand that this authorization will remain in effect until I submit a written request for cancellation to the Somerset/Stilley Membership contact for the following year, that will be due by October 31.