MEMBER  REGISTRATION
 
   Home Club:
    
   Membership Type: Monthly EFT - All Access
    
   Enrollment Fee: $ 74.00
    
   First Month Dues: $ 0.00
    
   Last Month's Dues: $ 0.00
    
    
   Total Due Today: $
   
   Billing Begins: 09/01/2017
    
   Monthly Dues: $ 29.99
    
   
 Jump start your program with discounted PT specials
        
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  5 Sessions $ 99.00  
        
 PERSONAL  INFORMATION
   
     First Name / MI
     Last Name
     Address 1
     Address 2
     City / State
     Zip
     Birthday
   
   
Home Phone
Cell Phone
E-Mail
Confirm E-Mail
Drivers License #
Emergency Contact
Emergency Phone
Hear About us?
   
 
 BILLING  INFORMATION
 
   
    Bank Name
    Routing/Transit Number
    Account Number
   
    
    How would you like to pay today?
    Credit Card Type
    Credit Card Number
    Expiration Month/Year /
   
 
 TERMS  AND  CONDITIONS
 
 I have read and agree to the cancellation policy. Click to view
 I have read and agree to the annual membership fee policy. Click to view
 I have read and agree to the membership terms and club rules. Click to view
 I have read and agree to the waiver. Click to view
 
 
Member
 
Parent/Guardian