Wellness Recreation Membership Application Your membership includes the following package: Unlimited use of BOTH fitness centers Unlimited use of BOTH open gyms Unlimited use of BOTH locker rooms Unlimited use of BOTH open swims and lap swims Unlimited use of Family FunPlex children’s room Use of racquetball courts (Greeley Rec Center) Use of rock climbing wall (Greeley Rec Center, certification required). Unlimited use of Adventure Minature Golf (Family FunPlex) Unlimited use of walking track (FunPlex) * “Family” is up to 2 adults and 4 children (age 18 and under) living in the same household. Each family member above the initial six please contact Amanda Gustafson * Proof of residence is required. * Employee must be present with family members when obtaining membership card.Membership Type * RequiredEmployee Only $25 (one-time fee)Spouse/Domestic Partner $20/month (or $9.23 per paycheck)Family $40/month (or $18.46 per paycheck)Applicant InformationName * Required First Middle Initial Last Home Address * Required Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone * RequiredAlternate Phone (Work/Landline)Mailing Address (If different than above) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email * Required Birth date * Required MM slash DD slash YYYY Gender * Required Male Female Consent * Required I understand and agree that I, and my family members, if applicable, will adhere to the terms outlined in the Agreement.When paying for services with a personal check: Disclosure of Social Security number and other personal information is mandatory. All information furnished will be used to identify, to this activity, writers whose checks have been returned unpaid. Request for this information is made pursuant to the authority of Title 5, U.S.C. Section 301 & Title 10, U.S.C. Section 5031. Terms of Use Membership and/or wellness cards must be submitted to Front Desk staff each time members use the facility. A replacement fee of $10 per card will be charged for each annual membership card that is lost. Memberships are not refundable. No retroactive refunds or discounts will apply. All existing facility rules apply. Facility hours and program offerings are subject to change. Occasionally, programs may be delayed due to special events.