Please be advised that all information is required; you will not be able to submit the form unless you fill it out completely.
Emergency Phone # :
Please select type of membership:
$480.00 September 1, 2014 - August 31, 2015
$360.00 September 1, 2014 - May 31, 2015
$190.00 January 1, 2015 - May 31, 2015
$135.00 June 1, 2015 - August 31, 2015
Have you previously had a gym membership to Northeastern University:
I hereby acknowledge and accept the above.
(your initials will act as your electronic signature)
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