Rec Center Account Registration Form

Rec Center Account Registration Form

Enter your personal account information
(BGSU students, faculty, and staff can log in to MyRec.bgsu.edu using their BGSU username and password and do not need to complete this form.)
Full name of primary account holder:

First NameLast Name
Date of Birth of primary account holder:

MonthDayYear
Date
Gender of primary account holder (female or male must be indicated in order to rent a locker):
BGSU affiliation of primary account holder:
Phone:
Email:
Home address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Account purpose - Please select the program or membership for which you wish to register:

Other
- Spouse full name:
  
  First NameLast Name
- Spouse gender (female or male must be indicated in order to rent a locker):
- Spouse date of birth:
  
  MonthDayYear
  Date
- Dependent 1 - full name
  
  First NameLast Name
- Dependent 1 - date of birth
  
  MonthDayYear
  Date
- Dependent 1 - gender (female or male must be indicated in order to rent a locker):
- Dependent 2 - full name
  
  First NameLast Name
- Dependent 2 - date of birth
  
  MonthDayYear
  Date
- Dependent 2 - gender (female or male must be indicated in order to rent a locker):
- Dependent 3 - full name
  
  First NameLast Name
- Dependent 3 - date of birth
  
  MonthDayYear
  Date
- Dependent 3 - gender (female or male must be indicated in order to rent a locker):
- Additional dependents - Please list name, birthdate, and gender for additional dependents:
- Questions/Comments:
- Should be Empty: