Fitness Center Membership Application

Email address *

Northern Essex Communtiy College

Fitness Center Membership Application

Membership Types and Costs:

NECC Student, Employee, Retiree, or Board Member and their spouse or child(ren) under the age of 26: NO CHARGE
NECC Alumni: $100
Family Membership (includes 2 adults and 2 children (17 and under): $200

Payment is accepted by check only. Please make payable to NECC Athletics.
Children under age 13 must be accompanied by an adult.
Children under age 15 are not allowed on weight equipment.
All year memberships are valid 12 months from start date.
Applicant is responsible for all add on members on the application.
Applicant agrees to follow all rules and regulations of the Fitness Center and NECC.
You are exercising at your own risk. You must also complete the online Risk and Consent waiver as it releases NECC, the Athletic Department, and Fitness Center of responsibility for injuries you may incur while exercising in the facility.
Failure to follow rules and regulations will result in suspension of membership privileges.

Please select membership type from the list below. Fees must be paid in person at the Fitness Center for your membership to be complete. *

Applicant Name *

Street Address *

City *

State *

Zip *

DOB *

NECC ID #

Name of emergency contact *

Relationship *

Phone number of emergency contact. Please include an alternate if there is one *

Add On Member #1 (if applicable)

Add on Member #1 DOB

Add on Member #2 (if applicable)

Add on Member #2 DOB

Add on Member #3 (if applicable)

Add on Member #3 DOB

I certify that the above information is complete and accurate to the best of my knowledge. I have read and understand all information on the application. I also understand falsifying information can result in my membership being revoked. *

Signature *

Date *

Parent/Guardian Signature (if member is under 18)

Date

* required field