Benefits-Eligible Faculty and Staff Membership Form

Annual SRC Membership (Valid for one year from date of activation)

$270 (you only pay taxes)

 

Important tax information
By submitting the form below, I hereby authorize the payroll department to deduct taxes from my paycheck. I understand this agreement is non-revocable and cannot be refunded for any reason. I understand that $270 will be reported as extra income, and I will be taxed on this amount.

Pay cycle as defined by payroll and how often you receive your paycheck (biweekly or semimonthly)
I have read and agree to all information in the Student Recreation Center membership contract below.
Please indicate if you would like your membership auto-renewed each year.

Student Recreation Center membership contract (printable)

University Recreation
Western Michigan University
1903 W Michigan Ave
Kalamazoo MI 49008-5477 USA
Phone (269) 387-4732
Fax (269) 387-3766

Location
2000 Student Recreation Center, Mail Stop 5447