Fitness Time: Pre-Sale 1 Year Paid In Full

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

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Birth Date

Gender

Male Female Other

Monthly Payment

$0

Amount Due Today

$264.99

Service	Down Payment	Recurring	Rollover	Visits
Member 1
PIF Membership Dues	$249.99	$0	$0.00	0
Sub-Total	$249.99	$0
Tax	$15.00	$0.00
Total	$264.99	$0

Payment Info

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