North Little Rock Athletic Club: Senior Individual - North

Primary Member Information

First Name

M.I.

Last Name

Address 1

Address 2

City

State / Province

Zip / Postal Code

Home Phone

OK to Contact Home Phone

Preferred Phone

Home

OK to Contact Email?

Emergency Contact

Name

Phone

Birth Date

Gender

Male Female Other

Monthly Payment

$54.75

$48.91

Service	Down Payment	Recurring	Rollover	Visits
Member 1
Joining Fee	$35.00	$0.00	$0.00	0
Unlimited group exercise classes	$0.00	$0.00	$0.00	0
Risk free cancellation policy	$0.00	$0.00	$0.00	0
Members only discounts	$0.00	$0.00	$0.00	0
$60 worth of guest passes	$0.00	$0.00	$0.00	0
Access to NLRAC	$0.00	$50.00	$0.00	0
Access to NLRAC	$9.66			0
Sub-Total	$44.66	$50.00
Tax	$4.25	$4.75
Total	$48.91	$54.75

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

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