Vermont Sport & Fitness Club: Annual 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

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Add-Ons for this member

Monthly Locker Rental

$72.00 down $0.00 / month

Monthly 1st Payment

$1424.17

Service	Down Payment	Recurring	Rollover	Visits
Member 1
Startup Fee	$55.00	$0	$0.00	0
Annual Adult	$1276.00	$0	$0.00	0
Sub-Total	$1331.00	$0
Tax	$93.17	$0.00
Total	$1424.17	$0

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