BOLD XTREME: 1 Xtreme Only

This plan requires 1 member with a maximum of 8 members.

How many total members would you like on this plan?

* This plan requires a minimum number of members including the primary member.

(1) 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?

Add-Ons for this member

Day Care

$10.00 down $10.00 / month

$99.00

$148.00

Service	Down Payment	Recurring	Rollover	Visits
Member 1
Enrollment Fee	$49.00	$0.00	$0.00	0
Membership Dues	$99.00	$99.00	$0.00	0
Sub-Total	$148.00	$99.00
Tax	$0	$0
Total	$148.00	$99.00

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

Maintenance Fee (Per member) of $59.00 will be billed on a Annual basis starting 10/1/2025

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