Energy Health Clubs (Cotati): 1 Year March Mad FRNDS+FAM JOL

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

5 Personal Training Sessions

$125.00 down $0.00 / Year

3 Personal training session special

$99.00 down $0.00 / Year

Annual 15th Payment

$249.00

$300.00

Service	Down Payment	Recurring	Rollover	Visits
Member 1
General Facility	$300.00	$249.00	$249.00	0
Sub-Total	$300.00	$249.00
Tax	$0	$0.00
Total	$300.00	$249.00

Payments will then be processed on a Annual 15th basis there after.

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