Gym Membership Application

Primary Member Information

Last Name First Name Date of Birth Address City State Zip Code Phone Number Email Address

Secondary Member Information

Check one that applies Couple Dependent/Minor (Age 15-17) Last Name First Name Date of Birth Phone Number Email Address

Emergency Contact Information (One Per Member)

Name Phone Number

Terms and Conditions -- Signature Required Below

I Agree To the Terms that Membership cards are not transferable and the Recreation Center staff reserves the right to revoke membership privileges if cards are used in this manner * I Agree To the Terms that Drexel Recreation Center memberships are non‐refundable and cannot be placed on hold unless in cases of the following *

‐ Formal leave of absence and sabbaticals (documented verification required)

‐ Changes in medical condition resulting in physical limitations (physician documentation required)

I Agree To the Terms that Members must be in compliance with all Drexel University policies & Drexel Recreation Center rules and regulations * Primary Member Signature Secondary Member Signature Date

Contact

Fall Term Hours

Mon - Thurs: 6:00am - 11:00pm
Friday: 6:00am - 10:00pm
Sat: 8:00am - 10:00pm
Sun: 10:00am - 10:00pm