Northampton Athletic Club: EFT Online

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?

Birth Date

Add-Ons for this member

Pickleball Reservation

$0.00 down $5.00 / month

Towel Rental

$0.00 down $5.00 / month

Monthly Payment

$49.00

$79.74

Service	Down Payment	Recurring	Rollover	Visits
Member 1
Processing Fee	$25.00	$0.00	$0.00	0
Membership Dues	$0.00	$49.00	$0.00	0
Membership Dues	$54.74			0
Orientation	$0.00	$0.00	$0.00	2
Sub-Total	$79.74	$49.00
Tax	$0	$0
Total	$79.74	$49.00

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

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