Little Rock Racquet Club: Senior Individual - Racquet

Primary Member Information

First Name

M.I.

Last Name

Address 1

Address 2

City

State / Province

Zip / Postal Code

Home Phone

OK to Contact Home Phone

Preferred Phone

Home

OK to Contact Email?

Emergency Contact

Name

Phone

Birth Date

Gender

Male Female Other

Monthly Payment

$98.85

$287.96

Service	Down Payment	Recurring	Rollover	Visits
Member 1
Unlimited group exercise classes	$0.00	$0.00	$0.00	0
Risk free cancellation policy	$0.00	$0.00	$0.00	0
Members only discounts	$0.00	$0.00	$0.00	0
$80 worth of guest passes	$0.00	$0.00	$0.00	0
Access to LRRC	$0.00	$91.00	$0.00	0
Access to LRRC	$44.10			0
Joining Fee	$221.00	$0.00	$0.00	0
Sub-Total	$265.10	$91.00
Tax	$22.86	$7.85
Total	$287.96	$98.85

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

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