Member 1 * First Name Last Name Date of Birth * MM DD YYYY Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Membership # Date * MM DD YYYY Member 2 * First Name Last Name Date of Birth * MM DD YYYY Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Membership # * Member 2 Date MM DD YYYY Add-Ons * Classes Tanning Personal Training None Tanning Pin Code If applicable Initiation * $35/ea 1st Month * $30/ea Add-Ons $ Total Due * $ Payment Method * Cash Card Check Bank Account & Routing Numbers / Credit Card Number * Reoccurring payments will be billed monthly for a minimum of 12 months on or around the 10th day of the month. Expiration Date (If Applicable) MM DD YYYY CVC (3 Digit Code) (If Applicable) Bank Account & Routing Numbers / Credit Card Number * Reoccurring payments will be billed monthly for a minimum of 12 months on or around the 10th day of the month. Expiration Date (If Applicable) MM DD YYYY CVC (3 Digit Code) (If Applicable) Terms and Conditions * I have read and agree to all terms and conditions of this membership Signature (Member 1) * By typing my name below, I understand and agree to all terms and conditions and that this form of electronic signature has the same legal force and effect as a manual signature. Signature (Member 2) * By typing my name below, I understand and agree to all terms and conditions and that this form of electronic signature has the same legal force and effect as a manual signature. Thank you! Terms & Conditions
