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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
Male
Female
Decline to State
Emergency Contact
Emergency Contact Phone Number
Do you live in University Glen?
Yes
No
Classification
required
CI Faculty
CI Staff
Non/CI Staff: University Glen Resident
If Faculty or Staff, please list department:
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