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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

Gym Membership Application