Flex Employee Discount Fitness Pass Order Form

Part-time and flex employees at the City of Orem are eligible for a family pass at the Orem Family Fitness Center for over 75% off the regular price. It is just $100 plus tax!

Employee Number

Department

Job Title

Phone Number

Birth Date

Family Information

Married

Married with Kid(s)

Single with Kid(s)

Single

Minor living at home

Please provide the names and birth dates of the immediate family members to add to this pass.

Date you would like the pass to start. It will go one year from this date.

Agreement

*I confirm that the above information is correct. I further understand that misrepresentation of any information on this form may result in reduction or loss of membership privileges.

*FAMILY: A family is defined as a legally married couple, and their unmarried legally dependent children under age 24 living in the same household and all claimed on the same tax form.

*I also agree to be photographed and/or agree that my child may be photographed and I agree that such photos, with or without my name or the name of my child, may be published in the Department of Recreation's Facebook page the City of Orem's website and City of Orem brochures, flyers or other publications. I understand that the photos may be subject to reproduction and are no longer protected by state and federal privacy laws.

*I understand that all passes are not transferable.

*I understand that all passes are non-refundable.

*ALL SALES ARE FINAL - NO REFUNDS!

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First Name

Last Name

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