September 10, 2020 Platinum Membership OPT-IN Person Requesting Opt-In* First Name Last Name Type of Membership*Platinum IndividualPlatinum PartnerTAC IndividualAddress on file for Membership* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone:*Email:* Acknowledgement* Yes I have read and understand URI Campus Recreation policies & procedures. Δ