Somerset Point & Stilley Membership Program Enrollment

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First Name

Last Name

Employee or Retiree

If you will be retiring on or before end of current year, please select the “Retiree” Option.

Employee Number

Mail Code

Home Address

City, State, Zip Code

Email Address

Phone Number

Work Extension

Eligible Dependents ?

Do you have dependents?
Yes No

Do you have a spouse?
Yes No

Requested Membership
Annual Membership (Active Employees Only) ($78 — $3.25/Pay Period)
Annual Camping Permit ($120 — $5/Pay Period)
Annual Storage Rental ($600 — $25/Pay Period)

Total

Payroll Deduction (24 Pay Periods)

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 acknowledge that I have read and agree to the membership guidelines.