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3. Plan Details
4. Personal Info
Commons: Commons Agreement
This plan requires 1 member with a maximum of 10 members.
How many total members would you like on this plan?
1 (min)
2
3
4
5
6
7
8
9
10 (max)
* 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
Email
OK to Contact Email?
Emergency Contact
Name
Phone
Birth Date
Gender
Male
Female
Other
What group ex classes interest you?
All Group Ex Classes
Community Classes
High intensity training
Indoor cycling
Not interested in group ex
Not present
Pilates
Strength training
Therapy Only
Water aerobics
Yoga
What activites interest you?
Basketball
Free weights
Not present
Pickleball
Racquetball
Running
Strength machines
Swimming
Therapy Only
What are you looking to accomplish?
All the above
Gain strength
Greater flexibility
Improve endurance
Improve quality of life
Longevity
Lose weight
Not present
Therapy Only
Annual Payment
$0.00
Amount Due Today
$0.00
Details
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Service
Down Payment
Recurring
Rollover
Visits
Member 1
Commons Program
$0.00
$0.00
$0.00
0
Sub-Total
$0.00
$0.00
Tax
$0
$0.00
Total
$0.00
$0.00
Payment Info
Payment Info
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