Naples Family Fitness: Level 1

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?

Birth Date

Gender

Male Female Other

Source

Add-Ons for this member

Kid 1

$0.00 down $19.99 / month

Kid 2

$0.00 down $19.99 / month

Kid 3+

$0.00 down $14.99 / month

Monthly 1st Payment

$42.79

$135.54

Service	Down Payment	Recurring	Rollover	Visits
Member 1
General Facility	$0.00	$39.99	$0.00	0
General Facility	$36.68			0
Last Month Dues	$39.99	$0.00	$0.00	0
Initiation Fee 1st	$50.00	$0.00	$0.00	0
Sub-Total	$126.67	$39.99
Tax	$8.87	$2.80
Total	$135.54	$42.79

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

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