Centrastate Fitness & Wellness Center: F&W Student Fitness 2024

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

Source

Monthly Payment

$75.70

Amount Due Today

$136.33

Service	Down Payment	Recurring	Rollover	Visits
Member 1
Personal Training Orientation	$0.00	$0.00	$0.00	2
Body Composition Analysis	$0.00	$0.00	$0.00	4
Pilates Demo	$0.00	$0.00	$0.00	1
Personal Training Re-Eval	$0.00	$0.00	$0.00	16
Swim Lesson Demo	$0.00	$0.00	$0.00	1
Membership Dues	$0.00	$71.00	$0.00	0
Membership Dues	$97.86			0
Administration Fee 1	$30.00	$0.00	$0.00	0
Sub-Total	$127.86	$71.00
Tax	$8.47	$4.70
Total	$136.33	$75.70

First Monthly Payment Date: 6/1/2024

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

Other Fee Information

Maintenance Fee 2022 (Per member) of $40.00 will be billed on a Annual basis starting 11/1/2024

Payment Info

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Centrastate Fitness & Wellness Center: F&W Student Fitness 2024

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

Monthly Payment

Amount Due Today

First Monthly Payment Date: 6/1/2024

Other Fee Information

Payment Info

Payment Info

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