Iron Works Health Club: 6 Month Prepaid Membership

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

Monthly Payment

$279.28

Service	Down Payment	Recurring	Rollover	Visits
Member 1
PIF Membership Dues	$204.00	$0	$0.00	0
Initiation Fee	$49.00	$0	$0.00	0
Key Tag Fee	$5.00	$0	$0.00	0
Free 30 min Personal Training Session	$0.00	$0	$0.00	1
Unlimited Group Fitness Classes	$0.00	$0	$0.00	0
Sub-Total	$258.00	$0
Tax	$21.28	$0.00
Total	$279.28	$0

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