Edgewater Fitness: Parkinson's Bi-weekly EF

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 #

Who referred you? Full Member Name. (Or N/A)

Which location are they a member at? (Or N/A)

Add-Ons for this member

Regular Locker

$0.00 down $12.50 / every 2 weeks

Bi-Weekly Payment

$25.00

Amount Due Today

$105.11

Service	Down Payment	Recurring	Rollover	Visits
Member 1
Dues	$0.00	$25.00	$25.00	0
Dues	$16.11			0
Admin Processing Fee	$39.00	$0.00	$0.00	0
Last 2 Billing Cycles	$50.00	$0.00	$0.00	0
Sub-Total	$105.11	$25.00
Tax	$0	$0
Total	$105.11	$25.00

First Bi-Weekly Payment Date: 5/9/2025

Payments will then be processed on a Bi-Weekly basis there after.

Payment Info

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Edgewater Fitness: Parkinson's Bi-weekly EF

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

Bi-Weekly Payment

Amount Due Today

First Bi-Weekly Payment Date: 5/9/2025

Payment Info

Payment Info

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