Richmond Athletic Club: Paid In Full- 12 month

This plan requires 1 member with a maximum of 2 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

Gender

Male Female Other

Drivers License #

Add-Ons for this member

Locker Service

$96.00 down $0.00 / every 0 months

$468.52

Service	Down Payment	Recurring	Rollover	Visits
Member 1
PIF Credit Card Fee	$12.00	$0	$0.00	0
Card Fee	$5.00	$0	$0.00	0
Enrollment Fee $25	$25.00	$0	$0.00	0
24 HR Access	$400.00	$0	$0.00	0
Sub-Total	$442.00	$0
Tax	$26.52	$0.00
Total	$468.52	$0

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