Staff Membership Sign Up Form

By completing this form you are signing up to a rolling monthly membership for the Sports Centre at Colchester campus.

You must confirm you have read the terms and conditions of the scheme by ticking the boxes before you can submit your form.

PLEASE NOTE: no money will be deducted from your salary on submission of this form.

Title	Miss Mrs Ms Mr Mx Dr Professor Rev Other
First name*	Please enter your first name.
Surname*	Please enter your surname.
Department*	Please enter your department.
Email*	Please emter your email address. This is not a valid e-mail address
Phone*	Please enter your telephone number.
Employee number (you can find this on your payslip)*	Please enter your payroll number.
Membership required*	Bronze £12.99 Silver £20.50 Gold £24.50 Please select a passport.
Induction video*	I have watched and understood the induction video I would like an induction in person and have not watched the induction video Please select an answer
Terms & conditions*	I have read and understood the terms & conditions. I am an employee of the University of Essex, UECS or WHH Ltd. By ticking this box I confirm I have read and understood the Salary Deduction Scheme terms and conditions. Ticking this box will be construed as signing the form. I have read and understood the health commitment statement.

*mandatory field