Fitness: Fitness - Family

This plan requires 3 members with a maximum of 10 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?

Emergency Contact

Name

Phone

Birth Date

$94.52

$126.38

Service	Down Payment	Recurring	Rollover	Visits
Member 1
Enrollment Fee	$20.00	$0.00	$0.00	0
Access Card	$10.00	$0.00	$0.00	0
Membership Dues	$89.00	$89.00	$0.00	0
Sub-Total	$119.00	$89.00
Tax	$7.38	$5.52
Total	$126.38	$94.52

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

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