Wilson's On Rangeline: 2. All Fitness Mth to Mth

This plan requires 1 member with a maximum of 6 members.

How many total members would you like on this plan?

* 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

OK to Contact Email?

Birth Date

Add-Ons for this member

PT MAP Move Assess Plan

$149.00 down $0.00 / month

PT Boost

$59.00 down $0.00 / month

$75.53

$187.44

Service	Down Payment	Recurring	Rollover	Visits
Member 1
Activation Fee	$100.00	$0.00	$0.00	0
Forum/Rangeline EFT	$0.00	$69.95	$0.00	0
Forum/Rangeline EFT	$73.60			0
Sub-Total	$173.60	$69.95
Tax	$13.84	$5.58
Total	$187.44	$75.53

Payments will then be processed on a Monthly 7th basis there after.

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