Hampshire Athletic Club: 1 Month PIF 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

Email

OK to Contact Email?

Birth Date

Monthly Payment

$0

Amount Due Today

$77.00

Service	Down Payment	Recurring	Rollover	Visits
Member 1
PIF Membership Dues	$77.00	$0	$0.00	0
Orientation	$0.00	$0	$0.00	2
Sub-Total	$77.00	$0
Tax	$0	$0
Total	$77.00	$0

Payment Info

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