The Fitness Center at Kernersville: Annual $25 Enrollment SPECIAL

Primary Member Information

First Name

M.I.

Last Name

Address 1

Address 2

City

State / Province

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Home Phone

Mobile Phone

OK to Contact Home Phone

OK to Contact Mobile Phone

Preferred Phone

Home

Mobile

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Emergency Contact

Name

Phone

Birth Date

Annual Payment

$0.00

$564.00

Service	Down Payment	Recurring	Rollover	Visits
Member 1
Membership Dues	$539.00	$0.00	$0.00	0
Unlimited Classes	$0.00	$0.00	$0.00	0
3 Free Guest Passes	$0.00	$0.00	$0.00	3
Enrollment Fee	$25.00	$0.00	$0.00	0
Sub-Total	$564.00	$0.00
Tax	$0	$0
Total	$564.00	$0.00

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