PACKER HALL

RECREATION CENTER

MEMBERSHIP AGREEMENT

Please Make Check Payable To: TCNJ Recreation Services

Last Name:_________________________ First Name:____________________ M:___

Spouse Name: ______________________ Dependents: _________________________

(If Family Membership) (If Family Membership)

Home Address:___________________________________________________________

(City) (State) (Zip)

Home phone: ( )_____________________ Work phone: ( )__________________

Email:___________________________ License Plate #: ____________________

(Permits for Alumni/Special Only – Lots #4-6)

In case of emergency, contact:______________________ Phone: ( )______________

Membership Type: Tennis: __________ Racquetball: __________

** Seasonal Tennis: __________ Fitness Room: __________

(See Note Below)

(CIRCLE ONE)

Alumni Individual or Family

Alumni (Year Graduated): _______________ *Submit Copy of Alumni Card

Faculty/Staff Individual or Faculty/Staff Family

Special Individual or Family

Note: If Seasonal Tennis Membership Please List Group Leader That You

Will Be Playing With: ___________________________________

Day/Time Playing: ___________________________________

(Office Use Only)

Amount Received: _________________________________

Check/Cash

Membership Type: _______________________

Date Received: ___________________________ Membership #: ________________

Date Sent: ___________________________ Parking Permit #: ______________