Vitality Wellness Rebate Gym Contract & Membership
Documentation
Member Name:______________________________________________________________________
SLU Banner #:________________________________________________________________________
Vitality Year:___________________________ Today’s Date:_____________________________
This document is to confirm that the member listed above is an active
member of the Simon Recreation Center (SRC) at Saint Louis University.
Date Joined
____ Before the start of this Vitality year (Oct. 1
st
)
____ During this Vitality Year – Exact Date:___________________________
Type of Membership
____ Faculty/Staff Payroll Deduction ($350/year)
____ Faculty/Staff Non-Payroll Deduction ($350/year)
____ Spouse ($300/year)
____ Other:________________________
Amount Paid this Vitality Year
____ $350
____ $300
____ Other: ____________________
For any questions regarding this Membership Documentation, please contact the staff
listed below:
Samantha McLeod
Member Services Coordinator, Department of Campus Recreation
314-977-3973 | samantha.mcleod@slu.edu
CAMPUS
RECREATION &
WELLNESS
3639 Laclede Ave.
St . Louis, MO
63108
P 314-977-3181
F 314-977-3555
w w w .slu.edu
