Benefits-Eligible Faculty and Staff Membership Form

Spring - Fall 2021 (January 11, 2021 through January 9, 2022)

$270 (you only pay taxes)

Membership begins on the first semester day based on the University calendar.

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.

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