Preceptor Perks Program Membership Form

Please Note:

Preceptors must be assigned to a student for the semester during which they are purchasing a membership.
The cost of $25 is intended to cover the cost of your membership card. Membership cards are valid for one year, not to exceed the terms of the employment.
Parking permits are required for parking on the GVSU campus. A permit can be obtained at the GVSU Public Safety Office with a current membership card and driver's license. Parking permits are for Rec Center use only; improper use of permits may result in campus Parking/Traffic fines.

Preceptor Information

First Name *

Last Name *

Phone *

Home Address *

Please enter your email address *

Membership Card Information

Do you have an existing membership card? *

What is the ID number on the back side of your card? *

Photo for Membership Card: Photos should be clear with faces unobstructed (it does not need to be professional quality; any selfie type photo will be accepted). *
Please upload a file with the extension .bmp, .gif, .jpeg, .jpg, .png, .psd, or .tiff with a maximum size of 10 MB.

Emergency Contact Information

First Name *

Last Name *

Phone *

Relationship to Member *

Additional Emergency Contact

First Name

Last Name

Phone

Relationship to Member

Family Membership Options

As a perk of your leadership as a preceptor at GVSU, you are eligible to purchase a family membership at the Alumni rate (with the same restriction). If you are interested in this option, please email [email protected] or call 616-331-3313.

Terms and Conditions

Please review the Athletic and Recreation Facilities Policies and Guidelines prior to submitting your application:

Athletic and Recreation Facilities Policies & Guidelines

Membership Agreement *

By signing this form, you are agreeing to uphold all Athletic and Recreation Facilities Policies and Guidelines at all times while utilizing any GVSU Athletic and Recreation Facility.

Page last modified December 3, 2025

Report a problem with this page