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3. Plan Details
4. Personal Info
Club Fit Briarcliff: Program Billing Membership
This plan requires 1 member with a maximum of 10 members.
How many total members would you like on this plan?
1 (min)
2
3
4
5
6
7
8
9
10 (max)
* This plan requires a minimum number of members including the primary member.
(1) Primary Member Information
First Name
M.I.
Last Name
Address 1
Address 2
City
State / Province
Zip / Postal Code
Home Phone
Mobile Phone
OK to Contact Home Phone
OK to Contact Mobile Phone
Preferred Phone
Home
Mobile
Email
OK to Contact Email?
Birth Date
Gender
Male
Female
Other
Monthly Payment
$0.00
Amount Due Today
$0.00
Details
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Service
Down Payment
Recurring
Rollover
Visits
Member 1
Account Registration Fee
$0.00
$0.00
$0.00
0
Sub-Total
$0.00
$0.00
Tax
$0
$0.00
Total
$0.00
$0.00
Payment Info
Payment Info
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