ZONE5 Fitness: Zone5 Month to Month

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?

Emergency Contact

Name

Phone

Birth Date

Source

Did anyone at the club assist you?

MONTHLY Payment

$69.00

$71.21

Service	Down Payment	Recurring	Rollover	Visits
Member 1
General Dues	$0.00	$69.00	$0.00	0
General Dues	$52.21			0
Initiation Fee	$19.00	$0.00	$0.00	0
Sub-Total	$71.21	$69.00
Tax	$0.00	$0.00
Total	$71.21	$69.00

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

Annual Fee (Per member) of $25.00 will be billed on a ANNUAL basis starting 3/1/2022

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