Faculty/Staff/CSU Pass Recreation Center Membership Form

Personal Information

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
Emergency Contact
Emergency Contact Phone Number
Do you live in University Glen?
Classification
If Faculty or Staff, please list department: