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Gym Membership Application

Primary Member Information

Last Name

First Name

Date of Birth

YearMonthDay

Address

City

State

Zip Code

Phone Number

Email Address

Secondary Member Information

Check one that applies

Couple
Dependent/Minor (Age 15-18)

Last Name

First Name

Date of Birth

YearMonthDay

Phone Number

Email Address

Emergency Contact Information (One Per Member)

Name

Phone Number

Terms and Conditions -- Signature Required Below

Membership cards are not transferable and the Recreation Center staff reserves the right to revoke membership privileges if cards are used in this manner.

Drexel Recreation Center memberships are non‐refundable and cannot be placed on hold unless in cases of:

‐ Formal leave of absence and sabbaticals (documented verification required)
‐ Changes in medical condition resulting in physical limitations (physician documentation required)*

Members must be in compliance with all Drexel University policies and Drexel Recreation Center rules and regulations

Primary Member Signature

Secondary Member Signature

Date

YearMonthDay