Edgewater Fitness: EF MTM

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

OK to Contact Email?

Emergency Contact

Name

Phone

Birth Date

Drivers License #

How did you hear about us?

Add-Ons for this member

EF Edgewater Dues

$0.00 down $0.00 / month

Guest Privileges

$0.00 down $25.00 / month

AAC Access

$0.00 down $35.00 / month

Monthly Payment

$55.00

Amount Due Today

$77.83

Service	Down Payment	Recurring	Rollover	Visits
Member 1
EF Dues Month to Month	$0.00	$55.00	$0.00	0
EF Dues Prorated Month to Month	$77.83			0
Pure Access	$0.00	$0.00	$0.00	0
Sub-Total	$77.83	$55.00
Tax	$0.00	$0.00
Total	$77.83	$55.00

First Monthly Payment Date: 7/1/2024

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

Payment Info

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Edgewater Fitness: EF MTM

This plan requires 1 member with a maximum of 1 members.

Monthly Payment

Amount Due Today

First Monthly Payment Date: 7/1/2024

Payment Info

Payment Info

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