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Cornell University

Preferred way for us to contact you if needed (check one)
Status (check one)
Membership Types (check one)
$175, prorated and runs from date of purchase through June 30 of fiscal year
$75, runs 4 months from date of purchase (can only be paid by credit card or check)
This option is only available to the Cornell benefits eligible employee who has Aetna CPHL health insurance; spouse/partner not eligible for this
Membership Payment Options (check one)
No charge to you. Membership fee is reimbursed up front through your Aetna CPHL insurance plan. This option is only available to the Cornell employee who has Aetna CPHL health insurance; spouse/partner not eligible for this.
Available to Cornell employees only; spouses/partners not eligible. Only available on 1-Year Wellness Recreation Membership type. By submitting this membership application I voluntarily request that Cornell deduct the membership fee from my wages throughout my continued membership.
Available to Cornell employees only; spouses/partners not eligible. Only available on 1-Year Wellness Recreation Membership type. By submitting this membership application I voluntarily request that Cornell deduct the membership fee from my wages throughout my continued membership.
Email wellness@cornell.edu or call (607) 255-5133 to make arrangements to remit payment by credit card/check; or stop by the Wellness Administrative office, room 305 Helen Newman Hall, M-F 9am-2pm, 3pm-5pm to remit payment.
I am requesting a scholarship application form be emailed to me. I will submit this form to cover up to 100% off of the membership fee. I understand that I will be contacted if there is any outstanding membership fee still due after the scholarship application form is processed.
Optional Free Wellness Individual Consultations (check all interested in)
Membership Policies, Waiver, Assumption Of Risk, and Informed Consent
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By signing and dating above, I agree to the terms of the Membership Policies, Waiver, Assumption Of Risk, and Informed Consent listed above for the duration of my Wellness Recreation Membership.