Fillable Brock Center Membership Application (Randolph-Macon College)

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Brock Center Membership Application (Randolph-Macon College)

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The Brock Center Membership Application (Randolph-Macon College) form is 1 page long and contains:

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Country of origin: US
File type: PDF

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R‐MCID:
Name:
Address:
Phone:
Email:
Membership
Amount Paid:
Dependents:
Brock Center Membership Application
________________________________________________________________________
H: _____________________ C: _____________________ W: ____________________
$120 ___________________________
Membership Fee – (Alumni 6 or more years) Membership Fee – (Alumni 15 years)
__________________________________ ___________________________
Name Relationship
__________________________________ ____________________________
Name Relationship
__________________________________ ____________________________
Name Relationship
__________________________________ ____________________________
Name Relationship
Participation in any Brock Center activities and use of the recreational and workout facilities
involves a risk of accidental injury. I acknowledge that all Brock Center facilities are used at
my own risk. I will assume all risks to my children or
participation in any use of the facilities at the Brock Center.
I have read and understand the above statement.
Signature
Staff Approval
myself that may occur during
Date
Date
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Brock Center Membership Application (Randolph-Macon College)

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Completed 27 August 2020

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