MEMBERSHIP APPLICATION
ENROLLMENT FEES
LIABILITY WAIVER
MEMBERSHIP APPLICATION ACKNOWLEDGEMENT OF POLICIES As a member, I, _________________________________ ________________________________, agree to uphold the policies of each facility within the Baruch College Athletic & Recreation Complex (ARC). I agree to pay all fees that are due in full. I agree to be contacted with information about my membership to the ARC. I understand, that as a new member, I must go in person to the ID Center to receive my ARC Member ID card. I agree that as a returning member, it is my sole responsibility to contact the ID Center for service on or to update my ID Card. I am aware that the fee for a replacement ID card is $10 to be paid at the ID Center. I understand that failure to contact the ID Center in order to get or update my ID card will result in a Public Safety block, which revokes access to the ARC. I have been informed that the ARC will be closed when the college is closed. I have also been informed that the ARC will be closed annually for a minimum of 2 weeks for facility maintenance. I understand that no credit or refund will be given for any facility closing. We reserve the right to enforce, or not enforce, these policies in our sole discretion, and these policies don’t create a duty or contractual obligation for us to act in any particular manner. We also reserve the right to amend these policies as needed.
I hereby declare that I am at least 18 years old, physically sound, and wish to use the Baruch College Athletics & Recreation Complex (ARC). I agree that I will undertake all activities in which I participate at my own risk. In consideration of Baruch College’s granting me (or any child or ward of mine) the privilege of participating in activities in the Athletics & Recreation Complex (ARC) fitness facility or pool, I hereby covenant not to sue and agree to release, discharge, hold harmless, and indemnify Baruch College, its employees, trustees, officers, affiliates, and assigns (collectively “Baruch College”) from and against any and all liability, claims, damages, actions or causes of action whatsoever, for omissions constituting negligence of Baruch College’s part, except for willful or wanton negligence or misconduct. I acknowledge that I am personally responsible for and voluntarily assume the risks of injury or damage to person or property. I have carefully read and freely signed this Liability Waiver and Acknowledgement of Policies. I understand and agree that no oral or written representations can or will alter the contents of this document.
MEMBER SIGNATURE _____/______/_______ DATE
BARUCH COLLEGE COMMUNITY •
•
Faculty & Staff o
$275 (annually)
o
137.50 (biannually)
Alumni Association Members o
$350 (annually)
o
$175 (biannually)
CUNY COMMUNITY •
•
Faculty & Staff o
$400 (annually)
o
$200 (biannually)
Graduate Center Students o
$100 (annually)
OUTSIDE COMMUNITY MEMBERS •
•
Regular (Members ages 17 and up) o
$600 (annually)
o
$300 (biannually)
o
$150 (quarterly)
Senior Citizens (ages 65 and up) o
$450 (annually)
o
$225 (biannually)
o
$112.50 (quarterly)
Baruch College ATHLETICS & RECREATION COMPLEX One Bernard Baruch Way, New York, NY 10010 Tel.: (646) 312 - 5061 Fax: (646) 312-5080 WWW.BARUCHATHLETICS.COM
Instructions: Please write clearly, and complete each section accurately to avoid denial of your application or delay in processing. Provide all required information.
MEMBERSHIP APPLICATION
Please check one.
First Time Member
PAGE 2
Returning / Renewing Member
NOTES:
MEMBER CONTACT INFORMATION
S T A F F
Gender Last Name First Name Mailing Address (Apt./ Ste./Rm.) City, State Zip code
O N L Y
Telephone Number Email address
Emergency Contact Info.
CHOOSE MEMBERSHIP CATEGORY & FEE PAYMENT SCHEDULE (must show appropriate ID) All Annual Memberships are from September to August. Payments can be made in full, biannually or on a quarterly (outside community members only) basis. For those who join after the September-August year has begun, the fees are pro-rated. The Graduate Center Student membership fee is not pro-rated.
(Circle your choice.)
FEES
Baruch College Community
275 137.5
X
Faculty/Staff
(6)
X
Faculty/Staff
300
150
(faculty/staff/alumni ID required)
(12)
(6)
CUNY Community
400
200
(CUNY faculty/staff/ GC Stu. ID required)
(12)
Outside Community
600
(State ID/ Driver’s License required.)
(12)
CATEGORY
(6)
(3)
Regular
FEES 350 175
CATEGORY BARUCH COLLEGE
X
100
Alumni Association Member Graduate Center Students
(12)
Certification of Enrollment required.
225 112.5 450 (6) (3)
Senior Citizen (65 and above)
(12) (6)
MEMBERSHIP PAYMENT OPTIONS We accept only: Check, Money Order, American Express, and Mastercard
Check payable to ‘Baruch College’
ENTER CHECK NUMBER IN THIS FIELD.
Money Order paid to ‘Baruch College’
ENTER MONEY ORDER NUMBER IN THIS FIELD.
CREDIT CARD PAYMENT REQUIREMENTS The Office of the Bursar at Baruch College requires that all Mastercard or American Express payments be submitted with a 9-digit SSN or Driver’s License# or State ID# or passport#. If these cannot be provided, please select one of the alternate payment options above.
Choose one:
American Express
Mastercard
Write card number: Write card expiration date: Write cardholder name as it appears: 9-Digit (SSN/DL#/State ID/Passport#): OFFICE USE ONLY. OFFICE USE ONLY. OFFICE USE ONLY. OFFICE USE ONLY. OFFICE USE ONLY. FEE PAYMENT SCHEDULE Full/Annual $ Payment #1 Sept. or ________ 1
Biannual 1
$
Quarterly
$
1
Enter Payment dates under the corresponding fee payment schedule as chosen by the member. Annual memberships purchased after the September-August year has begun will be pro-rated. EXCEPT Graduate Center Student memberships. Payment #2 Payment #3 Payment #4
November x February x May x
x 2 x
2 3 4
