JavaScript is disabled on your browser. Please enable JavaScript to use this site.
Faculty/Staff/CSU Pass Recreation Center Membership Form
Personal Information
Form fields marked with an asterisk (
*
) are required.
Please complete the following form to become a Recreation Center Member.
Contact Information - First Name
Contact Information - Last Name
Contact Information - Email Address
Contact Information - Phone Number
Contact Information - Address
Contact Information - City
Contact Information - State
Contact Information - Zip Code
Date of Birth
CI Faculty/ Staff ID # or Drivers License #
Gender
Male
Female
Decline to State
Emergency Contact
emergency contact and phone number CANNOT be the same as your personal phone number. membership will be denied if the numbers are the same.
Emergency Contact Phone Number
emergency contact and phone number CANNOT be the same as your personal phone number. membership will be denied if the numbers are the same.
Do you live in University Glen?
Yes
No
Classification
required
CI Faculty
CI Staff
Non/CI Staff: University Glen Resident
CSUCI Club Advisor
If Faculty or Staff, please list department:
If Club Advisor, name the club and the student president of the club. Failure to do so will result in a denied membership.
Next