MEMBER REGISTRATION
Membership Type:
4 Month Student Semester Membership
Enrollment Fee:
$ 310.96
Total Due Today:
$ 310.96
Term:
4 Months
*To add additional members or services to your account, please stop by the club to do so.
PERSONAL INFORMATION
Location:
PINNACLE H&F - FITCHBURG
PINNACLE H&F - CAPITOL SQUARE
First Name / MI
Last Name
Address 1
Address 2
City / State
AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NY
NV
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
WA
WI
WV
WY
Zip
Birthday
Home Phone
Cell Phone
E-Mail
Confirm E-Mail
Emergency Contact
Emergency Phone
Hear About us?
CORPORATE
COURTESY LIST DAY
DIRECT MAIL
DO A FRIEND FAVOR
DOOR HANGER
DRIVE BY
EMAIL MARKETING
FAX MARKETING
FAMILY
FLYER
FRIEND
FUND RAISER
GUEST
INTERNET
LEAD BOXES
MAGAZINE
MEMBER
MOVIE THEATRE
NEW MEM SURVEY
NEWSPAPER
OPEN HOUSE
POINT OF SALE
RADIO
SIGN
SILVERADO THEATRE
TV
WEBSITE
How would you like to pay today?
Credit Card Type
Visa
MasterCard
Discover
American Express
Credit Card Number
Expiration Month/Year
01
02
03
04
05
06
07
08
09
10
11
12
/
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
TERMS AND CONDITIONS
I have read and agree to the cancellation policy.
Click to view
I have read and agree to the membership terms and club rules.
Click to view
I have read and agree to the waiver of liability.
Click to view
Member
Parent/Guardian
WAIVER OF LIABILITY
I fully understand and acknowledge that: (a) recreational and fitness activities have inherent risks, dangers, and hazards; (b) my participation in such activities may result in injury or illness including, but not limited to, bodily injury, disease, strains, fractures, partial and/or total paralysis, death, or other ailments that could cause serious disability; and (c) these risks and dangers may be caused by the negligent acts and/or omissions of the representatives, employees, or volunteers of Pinnacle Health & Fitness, Inc., other members, accidents, or other causes.
Responsibilities of Participants. By execution of this document, and pursuant to Section 895.525 of the Wisconsin Statutes, I acknowledge that as a participant in a recreational activity, I have a responsibility to do all of the following: (a) act within the limits of my ability; (b) heed all warnings; (c) maintain control of my person and the equipment or devices I am using; and (d) refrain from acting in any manner that may cause or contribute to the death or injury of myself or another.
By my participation in recreational activities and for use of equipment, I hereby assume all risks and dangers and all responsibility for any injuries, losses and/or damages occurring during my use of the facility whether caused in whole or in part by the negligent acts and/or omissions, but not reckless or intentional acts, of the representatives, employees, or volunteers of Pinnacle Health & Fitness, Inc., or by any other person, except for reckless or intentional acts. I recognize that if this waiver of liability were not as broad as it is, the cost for my use of the facility would be considerably higher, and I do not wish to pay a considerably higher cost.
I acknowledge that I have read and understand the terms set forth above. I understand these terms apply to any minor family members who use the facility. By selecting one of the options above, and by signing below, I hereby waive my right to bargain for different terms.
CANCELLATION POLICY
You are permitted to cancel this contract until midnight of the third operating day after the date on which you signed the contract. If the facilities or services that are described in the contract are not available at the time you sign the contract, you have until midnight of the third operating day after the day on which you received notice of their availability to cancel the contract. If within the time period you decide you want to cancel this contract, you may do so by notifying Pinnacle Health & Fitness, Inc. by any writing mailed or delivered to Pinnacle Health & Fitness, Inc. at the address shown on the contract, within the previously described time period. If you do so cancel, any payments made by, less a user fee of no more than $3.00 per day of actual use, will be refunded within 21 days after notice of cancellation is delivered, and any evidence of any indebtedness executed by you will be cancelled by Pinnacle Health & Fitness, Inc, and arrangements will be made to relieve you of any further obligation to pay the same.
Thereafter, you may cancel this Agreement only if you become disabled and provide written evidence of the disability to Pinnacle Health & Fitness, Inc. at the address above. If Member is unable to make use of or receive the membership services contracted for because of death or disability, Member is liable for that portion of the total consideration proportional to the elapsed time portion of the contract at the time of death of disability. Other than for death or disability Member shall not be relieved of any obligation to make payment in full as herein agreed, and no deduction or allowance shall be made from any of the payments, by reason of Member failing to attend or use the facilities or services offered by Pinnacle Health & Fitness, Inc.
If the facilities or services described in the contract become unavailable or are no longer fully operational before full receipt of the services and use of facilities for which Member contracts, Member is liable for that portion of the total consideration proportional to the elapsed time portion of the contract at the time of unavailability: provided, however, this paragraph shall not restrict Pinnacle Health & Fitness, Inc.’s ability to (a) perform regular maintenance or make prompt equipment repairs, (b) make improvements to the facilities or services, or (c) replace a facility or service with a superior facility or service.
TERMS AND CONDITIONS OF MEMBERSHIP
1. MEMBERSHIP: Pinnacle Health & Fitness, Inc. agrees to and does here by sell, and member agrees to and does here by purchase, the following type of membership: New.
2. PAYMENT AND DISCLOSURES: Member agrees and promises to pay to the order of Pinnacle Health & Fitness, Inc. the amount of the membership pursuant to the terms contained herein.
3. NOTICE TO MEMBER.
A. Do not sign this before you read the additional provisions on the reverse side, even if otherwise advised.
B. Do not sign this if it contains any blank spaces.
C. You are entitled to an exact copy of any agreement you sign and member acknowledges that he has read and received a complete copy of this agreement.
D. You have the right to pay in advance the unpaid balance due under this agreement without penalty.
4. DEFAULT. In the event of default of Members payment(s), as defined by sec. 425.013 of the Wisconsin Statutes. Pinnacle Health & Fitness, Inc. shall give Member an opportunity to cure such default as required by sec 425.105 of the Wisconsin Statutes. In the event Member fails to cure said default within 15 calendar days after mailing of such notice to Member, the entire unpaid balance shall, at the option of Pinnacle Health & Fitness, Inc. becoming immediately due and payable.
5. RULES. All members upon entering Pinnacle Health & Fitness, Inc. shall sign in and show their membership card at the reception desk. Members shall observe all rules and regulations established by Pinnacle Health & Fitness, Inc. for the exercise and pool areas and, without irritation to the foregoing. Member agrees not to create a nuisance, disturb other members, or be guilty of moral turpitude or fraud while using Pinnacle Health & Fitness Inc. facilities. Breach of the paragraph shall permit Pinnacle Health & Fitness Inc. to revoke this membership. It is expressly understood and agreed by Member that the operating hours and schedule of Pinnacle Health & Fitness Inc. facility and services may vary.
6. Member is defined as any individual named in this contract. All terms and conditions stated in this contract are applicable to any and all named individuals in this contract. The provisions stated in this contract will automatically carry over to any continuation of membership beyond the original membership term stated on reverse.
7. RESPONSIBILITY OF A MEMBER. A Member engaged in physical activities and/or using the facilities of Pinnacle Health & Fitness, Inc. accepts the risks inherent in the activity. A Member is responsible to do all of the following:
1. Act within the limits of his or her ability;
2. Heed all warnings regarding participation;
3. Maintain control of his or her person and the equipment or devices the Member is using while participating; and
4. Refrain from acting in any manner that may cause or contribute to injury to him or herself or to other persons while participating.
The member recognizes and acknowledges that a violation of the foregoing constitutes negligence as per Wisconsin Statutes, section 895.525, Participation in Recreational Activities.
CANCELATIONS AND REFUNDS
9. RIGHT TO CANCEL. You are permitted to cancel this contract until midnight of the third operating day after the date on which you signed the contract. If the facilities or services that are described in the contract are not available at the time you sign the contract, you have until midnight of the third operating day after the day on which you received notice of their availability to cancel the contract. If within the time period you decide you want to cancel this contract, you may do so by notifying Pinnacle Health & Fitness, Inc. by any writing mailed or delivered to Pinnacle Health & Fitness, Inc. at the address shown on the contract, within the previously described time period. If you do so cancel, any payments made by, less a user fee of no more than $3.00 per day of actual use, will be refunded within 21 days after notice of cancellation is delivered, and any evidence of any indebtedness executed by you will be cancelled by Pinnacle Health & Fitness, Inc, and arrangements will be made to relieve you of any further obligation to pay the same.
Thereafter, you may cancel this Agreement only if you become disabled and provide written evidence of the disability to Pinnacle Health & Fitness, Inc. at the address above. If Member is unable to make use of or receive the membership services contracted for because of death or disability, Member is liable for that portion of the total consideration proportional to the elapsed time portion of the contract at the time of death of disability. Other than for death or disability Member shall not be relieved of any obligation to make payment in full as herein agreed, and no deduction or allowance shall be made from any of the payments, by reason of Member failing to attend or use the facilities or services offered by Pinnacle Health & Fitness, Inc.
If the facilities or services described in the contract become unavailable or are no longer fully operational before full receipt of the services and use of facilities for which Member contracts, Member is liable for that portion of the total consideration proportional to the elapsed time portion of the contract at the time of unavailability: provided, however, this paragraph shall not restrict Pinnacle Health & Fitness, Inc.’s ability to (a) perform regular maintenance or make prompt equipment repairs, (b) make improvements to the facilities or services, or (c) replace a facility or service with a superior facility or service.
10. NONASSIGNABILITY. It is expressly understood and agreed by member that this Agreement is not assignable or transferable and no right or privileges granted by this membership may be transferred or assigned by Member.
11. NOTICE OF ASSIGNABILITY BY PINNACLE HEALTH & FITNESS, INC. The payment obligation of Member under this Agreement with Pinnacle Health & Fitness, Inc. may be assigned to any bank or finance company and if so assigned, Member agrees to make payments to the bank of finance company as so directed. ANY HOLDER OF THIS CONSUMER CREDIT AGREEMENT IS SUBJECT TO ALL CLAIMS AND DEFENSES, WHICH THE DEBTOR COULD ASSERT AGAINST THE SELLER OF GOODS, OR SEVICES OBTAINED PURSUANT HERETO OR WITH THE PROCEEDS HEREOF. RECOVERY HEREUNDER BY THE DEBTOR SHALL NOT EXCEED AMOUNTS PAID BY THE DEBTOR HEREUNDER.
12. ENTIRE AGREEMENT CONSTRUCTION. The Agreement contains the entire Agreement between the parties and no promise, and no provisions, terms, warranties, representations or obligations whatsoever, either express or implied, other than those herein set forth shall be binding upon either party. This Agreement shall be construed in accordance with the laws of the State of Wisconsin. If any provisions of this Agreement shall be prohibited by or invalid under applicable law, such provision shall only be ineffective to the extent of each prohibition or invalidity, without invalidating the remaining provisions of this agreement.
13. TRIAL PERIOD. Member shall have the right to cancel this membership for full refund by notifying Pinnacle Health & Fitness, Inc. in writing by midnight, the fourteenth day after the date on which you signed the contract. Any new member incentives received by member must be returned in “Like New Condition”. The value of any incentives not returned in like new condition will be subtracted from any refund owed.
14. Moving Provision. In the event member moves outside of Dane County, member may buyout of the balance owing on this contract by paying a total of $89.00. Pinnacle Health & Fitness, Inc. reserves the right to verify new address prior discharging member of future obligations in this contract.
15. Month to Month. Any membership set up on a month to month (mo. to mo.) basis requires 30-day written notice to cancel. Termination may include an additional billing if a normal dues payment occurs within the 30 day period.
Automatic Withdrawal Authorization
I hereby authorize the financial institution named here to honor automatic monthly withdrawals from my account and payable to Pinnacle Health & Fitness, Inc. by sending automatic withdrawals notice to the financial institution named below, as a payment becomes due shall constitute notice of such payment due on this membership. When said financial institution honors the automatic withdrawal by charging my account, this shall constitute my receipt for payment. Any automatic withdrawal not honored will be subject to a $15.00 service charge.
Change of account requires 30 days notice by providing the necessary information to make such change