MEMBER  REGISTRATION
 
   Citizen Membership Plan Type:    Basic Membership
   Enrollment Fee:    $ 69.00
   First Month Dues:    $ 9.99
   Total Due Today:    $ 78.99
   Billing Begins:    07/20/2019
   Monthly Dues:    $ 9.99
   Term:    Month to Month
 
 PERSONAL  INFORMATION
   
     First Name
     Last Name
     Address 1
     Address 2
     City / State
     Zip
     Birthday
   
   
Home Phone
Cell Phone
E-Mail
Confirm E-Mail
Emergency Contact
Emergency Phone
Hear About us?
Service Rep 
   
 
 BILLING  INFORMATION
 
    How would you like to pay for your monthly dues?
     I want to use my credit card. ($5 per month service charge for credit card)
     I want to use my bank account.
    
    How would you like to pay today? -Same as monthly credit card
    Credit Card Type
    Credit Card Number
    Expiration Month/Year /
   
 
 TERMS  AND  CONDITIONS
 
 I have read and agree to the notice of dues renewal. Click to view
 I have read and agree to the membership terms and club rules. Click to view
 
 
You, the buyer, may cancel this contract without penalty, you may cancel it by delivering or mailing a written notice to the health studio. The notice must say that you do not wish to be bound by the contract and must be delivered or mailed before midnight of the third business day after you sign this contract. The notice must be mailed to Fit Republic, Attention: Member Services, 4120 Dale Road, Modesto, California 95356. If you cancel within three (3) days, the Club will refund to you, within thirty (30) days, all amounts you have paid.
 
 
Member
 
Parent/Guardian