Fitness Nation Bedford: Online Bedford $20

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

Gender

Male Female Other

Drivers License #

Source

Monthly 1st Payment

$21.65

Amount Due Today

$40.23

Service	Down Payment	Recurring	Rollover	Visits
Member 1
*Enrollment Fee	$0.00	$0.00	$0.00	0
*Membership Dues	$0.00	$20.00	$0.00	0
*Membership Dues	$17.16			0
*Last Month Dues	$20.00	$0.00	$0.00	0
Sub-Total	$37.16	$20.00
Tax	$3.07	$1.65
Total	$40.23	$21.65

First Monthly 1st Payment Date: 6/1/2025

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

Other Fee Information

*Annual Fee (Total) of $50.00 will be billed on a Annual basis starting 6/1/2025

Payment Info

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Fitness Nation Bedford: Online Bedford $20

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

Monthly 1st Payment

Amount Due Today

First Monthly 1st Payment Date: 6/1/2025

Other Fee Information

Payment Info

Payment Info

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