KS Fitness Center: Online Membership

This plan requires 1 member with a maximum of 10 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?

Emergency Contact

Name

Phone

Birth Date

Monthly 1st Payment

$15.98

Amount Due Today

$6.27

Service	Down Payment	Recurring	Rollover	Visits
Member 1
Monthly Virtual	$0.00	$14.99	$0.00	0
Monthly Virtual	$5.88			0
Sub-Total	$5.88	$14.99
Tax	$0.39	$0.99
Total	$6.27	$15.98

First Monthly 1st Payment Date: 5/1/2024

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

Other Fee Information

ANNUAL MAINTENANCE FEE (Total) of $30.00 will be billed on a Annually basis starting 1/1/2025

Payment Info

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KS Fitness Center: Online Membership

This plan requires 1 member with a maximum of 10 members.

Monthly 1st Payment

Amount Due Today

First Monthly 1st Payment Date: 5/1/2024

Other Fee Information

Payment Info

Payment Info

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