Vermont Sport & Fitness Club: Monthly Couple Gym Membership

Primary Member Information

First Name

M.I.

Last Name

Address 1

Address 2

City

State / Province

Zip / Postal Code

Home Phone

OK to Contact Home Phone

Preferred Phone

Home

OK to Contact Email?

Add-Ons for this member

Monthly Locker Rental

$5.00 down $5.00 / month

Monthly 1st Payment

$124.12

$177.07

Service	Down Payment	Recurring	Rollover	Visits
Member 1
Startup Fee	$55.00	$0.00	$0.00	0
Monthly Adult	$0.00	$116.00	$0.00	0
Monthly Adult	$110.49			0
Sub-Total	$165.49	$116.00
Tax	$11.58	$8.12
Total	$177.07	$124.12

Payments will then be processed on a Monthly 1st basis there after.

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