MEMBER  REGISTRATION
 
      Membership Type: STANDARD WEEKLY BILLED MEMBERSHIP
       
      Enrollment Fee: $
       
       
      Total Due Today: $
     
      Weekly Dues: $
     
      Term: Month to Month
     
 PERSONAL  INFORMATION
   
     First Name / MI
     Last Name
     Address 1
     Address 2
     Zip
     City / State
     Driver License #
     Social Security #
   
   
Birthday
Home Phone
Cell Phone
E-Mail
Confirm E-Mail
Gender
Emergency Contact
Emergency Phone
Hear about us
Referring Member
 
 BILLING  INFORMATION
 
    How would you like to pay for your dues?
     I want to use my credit/debit card.
     I want to use my bank account.
 
 TERMS  AND  CONDITIONS
 
 I have read and agree to the notice of dues renewal.
 I have read and agree to the membership terms.
 I have read and agree to the waiver and release of liability.
 
 
 PAYMENT
Credit Card #   /  
   


 
Member
 
Parent/Guardian/Payor