For Faculty & Staff Only: Name (Last, First, MI): _____________________________________________ Employee ID: ____________
Mail Box #: ______________ Phone#: ______________________ Email: ______________________________________________________________
Payment Option (Select):
Deduction Level
One-Time
Monthly
Includes
Deduction Breakdown

Financial Athletic Support Opportunity Group
(Deducted July thru following April in even distributions based on when form received)(Group Certificate & Tax Deduction Standard)
50 A Year - $50.00
1 time deduction
7.50 Bucks A Month - $75.00
$7.50 per month
10 Bucks A Month - $120.00
$12.00 per month
Tiger Club - $1,000
$100 per month
Football Tickets & Parking
(Deducted July thru April deadline in even distributions based on when form received)
The Siberian Package - $90.00
The Malayan Package - $70.00
The Tiger Pitt - $50.00
Home Games, Homecoming & GSU Game
Home Games & Homecoming
Home Games, & Homecoming
$9.00 per month
$7.00 per month
$5.00 per month
Click Here to View Seating Chart
Basketball Tickets
(Deducted July thru April deadline in even distributions based on when form received)
$125.00
Floor Seats
$75.00
Reserved Seats
$50.00
General Admission
$12.50 per month
$7.50 per month
$5.00 per month
Ultimate Fan Pass
(Deducted July thru April deadline in even distributions based on when form received)
$100 All Access
All Revenue Sports (Football, Basketball (M&W), Softball, & Baseball) $10.00 per month
$180 All Access
Employee + 1 -- All Revenue Sports (Football, Basketball (M&W), $18.00 per month
Softball, & Baseball)
Note: Special Seating Section designated for “Ultimate Fan” pass holders Football Malayan section and general seating at all other
home games.
**Deduction breakdown assumes form received the 1st part of July for processing. Deductions will be even distributed to meet goal amount based on when
form received and in compliance with prescribed deadlines.***Includes all regular season SSU Home Athletic Games
I authorize a monthly payroll deduction for the above selection(s) effective ______ day of _________ year 20__________.
Further, I understand that these selections will be deducted each month from my payroll in equal deductions until
the entire amount has been satisfied. In the event that my employment with the University is terminated or upon
resignation, any outstanding/remaining balance will deducted from my last payroll check. Due to the
Administrative burden this convenience creates, I understand that I cannot opt to cancel this agreement once
entered into.
Employee Signature_______________________________________________________ Date: ___________________________________
Please forward signed copy to Athletics at the attention of Melanie Harper; [email protected]
Revised 4/7/2016