Viterbo University - The University of Opportunity: Hope and Help

 Mathy Center Limited Plus One Membership

DO NOT PROCEED WITH THE REGISTRATION IF:

  1. The individual is not accompanied by his or her partner/spouse
  2. The individual does not have a photo ID present
  3. There is no proof of shared residency

 

Before you begin completing the registration form, inform the individual of the following: 

  1. The membership includes full facility access, including programs, during specified non-peak hours. Members will not have access to the facility from 2:00 - 5:00 p.m., during the work week.
  2. Do they understand these provisions?
    *You must make sure you (1) recite these lines and (2) ask the prospective member if they understand the guidelines.

 

 

     

 

First Name                                       Last Name   

                                                       

 Street Address 

 

 City                                            State               Zip Code  

                            

 Telephone                                    Email 

                       

 

Guidelines: 

               

          Name of Member:  

 or Driver's License

         Number:         

 

 :             

 

Membership Length (see term dates and fees here): 

 

 

 

 

 

Amount Received:  

                                                                                    

 Rec Sports Staff Completing Form:  

 

Almost complete! Select "Submit," and the follow the directions on the response page!