My Club-Fitness
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Salutation: | First Name: | Last Name: |
Date of Birth: |
Address: |
P.O. Boxes will not be accepted. |
City: | State: | Zip Code: |
Country: |
Phone: | Email: |
(ex. 999-999-9999) | (ex. first.last@domain.com) |
Married: | Dependents: |
If you have a family member, friend or colleague at the Club, please provide their name: |
Family Information
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Company Name: | Business Industry: |
Title: | Address: |
P.O. Boxes will not be accepted. |
City: | State: | Zip Code: |
Country: |
Phone: | Business Email: |
(ex. 999-999-9999) | (ex. first.last@domain.com) |
Review
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My Club Membership Dues
All dues to be billed on your next
member statement.
Total $0.00
All dues to be billed on your next
member statement.
Total $0.00
Contact Information
Name:
Address:
City, State and Zip:
Country:
Phone:
Email:
Spouse:
Dependents:
Address:
City, State and Zip:
Country:
Phone:
Email:
Spouse:
Dependents:
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All dues to be billed annually on your next member statement
Sub-total
$0.00
Sales Tax ( .00%)
$0.00
Total Due Today
$0.00
Primary Member Information
Name:
Address:
Address2:
City, State and Zip:
Country:
Phone:
Email:
Address:
Address2:
City, State and Zip:
Country:
Phone:
Email:
Billing Information
First Name: | Last Name: |
Zip code: | Payment Method: |
Card Number: | Expiration Date: |
By providing the above credit or debit card information, I/we, as the cardholder(s), hereby authorize the Club to charge my/our credit card to pay (i) the corresponding one-time initiation payment, including applicable taxes, associated with my/our membership as of the date my/our membership application is submitted, (ii) the corresponding dues payment(s) associated therewith, whether on an annual or monthly basis, as determined by me/us, in full, as such balance(s) become due, and (iii) any monthly statement balance for my/our membership account at the Club, including without limitation, all food and beverage charges, fees, service charges, and applicable taxes, in full, as such balances become due, (collectively (i), (ii), and (iii) as ¿Club Payments¿). I/we agree that payment of my/our Membership account, including all Club Payments, shall be paid in full when due. I/We further agree that the authority granted herein shall remain in full force and effect until the Club has received thirty (30) days¿ written notice from me/us of its revocation and shall automatically renew and extend to the dues payment obligations or each subsequent month or year, as applicable, regardless of any customary dues increase, unless terminated earlier in accordance with the terms herein. In the event the Club increases my/our applicable dues rate by more than five percent (5%) per annum, the Club shall notify me/us forty-five (45) days in advance of such increase.
I/we agree to maintain a current major credit card on file with the Club at all times. I/We understand that if any amounts are rejected by the credit card company I/we may be subject to any penalties or late charges referenced herein.
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We will contact you shortly to complete your enrollment, and we look forward to welcoming you to our Club family.
If you have any questions, please contact the membership office.
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