Gilmore-Amory Wellness Center: Individual

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

Emergency Contact

Name

Phone

Birth Date

Add-Ons for this member

Childcare

$0.00 down $25.00 / month

Locker

$0.00 down $0.00 / month

Small Locker

$0.00 down $5.00 / month

Large Locker

$0.00 down $10.00 / month

Monthly Payment

$40.00

Amount Due Today

$50.00

Service	Down Payment	Recurring	Rollover	Visits
Member 1
Enrollment Fee	$50.00	$0.00	$0.00	0
Membership Dues	$0.00	$40.00	$0.00	0
Class Pass	$0.00	$0.00	$0.00	0
Pool Pass	$0.00	$0.00	$0.00	0
Sub-Total	$50.00	$40.00
Tax	$0	$0
Total	$50.00	$40.00

First Monthly Payment Date: 7/15/2025

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

Payment Info

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Gilmore-Amory Wellness Center: Individual

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

Monthly Payment

Amount Due Today

First Monthly Payment Date: 7/15/2025

Payment Info

Payment Info

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