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Member Information

Member First Name*

Member Last Name*

Member Home Club*

Member Phone Number*

By providing your mobile number, you acknowledge that FFC may contact you via SMS if applicable. The suggested phone number format is (###) ###-####.

Member Email Address*

Add On Details

I Want To Add On:*

A Second Family Member: $25 + an additional $110/month
A Second Family Member + 1 Child ages 13 - 22: $25 + an additional $180/month
A Second Family Member + 2+ Children ages 13 - 22: $25 + an additional $240/month
1 Child Only ages 13 - 22. YOU MUST already have a second family member on your account: $25 + an add. $70/month
2+ Children Only ages 13 - 22. YOU MUST have a second family member on your account: $25 + an add. $130/month

A Second Family Member

A Second Family Member + 1 Child ages 13 - 22

A Second Family Member + 2+ Children ages 13 - 22

1 Child Only ages 13-22: YOU MUST have second family member on account

2+ Children Only ages 13-22: YOU MUST have second family member on account

Second Immediate Family Information

First Name*

Last Name*

Phone Number*

By providing your mobile number, you acknowledge that FFC may contact you via SMS if applicable. The suggested phone number format is (###) ###-####.

Email Address:*

Date of Birth*

Please enter a Preferred Date in the format of mm/dd/yyyy.

mm

dd

yyyy

Second Family Member Gender*

Female

Male

Child(ren) Information

First Name*

Last Name*

Phone Number*

By providing your mobile number, you acknowledge that FFC may contact you via SMS if applicable. The suggested phone number format is (###) ###-####.

Email Address:*

Date of Birth*

Please enter a Preferred Date in the format of mm/dd/yyyy.

mm

dd

yyyy

Child Gender*

Female

Male

Add a Second Child?

Yes

Child #2 First Name*

Child #2 Last Name*

Child #2 Phone Number*

By providing your mobile number, you acknowledge that FFC may contact you via SMS if applicable. The suggested phone number format is (###) ###-####.

Child #2 Email Address:*

Child #2 Date of Birth*

Please enter a Preferred Date in the format of mm/dd/yyyy.

mm

dd

yyyy

Child #2 Gender*

Female

Male

Add a Third Child?

Yes

Child #3 First Name*

Child #3 Last Name*

Child #3 Phone Number*

By providing your mobile number, you acknowledge that FFC may contact you via SMS if applicable. The suggested phone number format is (###) ###-####.

Child #3 Email Address:*

Child #3 Date of Birth*

Please enter a Preferred Date in the format of mm/dd/yyyy.

mm

dd

yyyy

Child #3 Gender*

Female

Male

Terms

Add On: Terms and Conditions*

I understand I will owe the prorated February Dues for my second family member + child.

I understand my monthly dues rate as of March 1, 2024 will increase by $180/month.

I understand that I must stop by the membership department to complete the add-on paperwork.

I understand that my family's access will begin once the in-club paperwork is completed.

Yes! I want to add a second family member + 1 child to my membership.

Add On: Terms and Conditions*

I understand I will owe the prorated February Dues for my second family member + children.

I understand my monthly dues rate as of March 1, 2024 will increase by $240/month.

I understand that I must stop by the membership department to complete the add-on paperwork.

I understand that my family's access will begin once the in-club paperwork is completed.

Yes! I want to add a second family member + child(ren) to my membership.

Add On: Terms and Conditions*

I understand I will owe the prorated February Dues for my child.

I understand my monthly dues rate as of March 1, 2024 will increase by $70/month.

I understand that I must stop by the membership department to complete the add-on paperwork.

I understand that my family's access will begin once the in-club paperwork is completed.

Yes! I want to add a child ONLY to my membership.

Add On: Terms and Conditions*

I understand I will owe the prorated February Dues for my second family member.

I understand my monthly dues rate as of March 1, 2024 will increase by $110/month.

I understand that I must stop by the membership department to complete the add-on paperwork.

I understand that my family's access will begin once the in-club paperwork is completed.

Yes! I want to add a second family member to my membership.

Add On: Terms and Conditions*

I understand I will owe the prorated February Dues for my children.

I understand my monthly dues rate as of March 1, 2024 will increase by $130/month.

I understand that I must stop by the membership department to complete the add-on paperwork.

I understand that my family's access will begin once the in-club paperwork is completed.

Yes! I want to add 2+ children to my membership.

Payment Information

Total Due Today

Billing Address:*

Street Address City State ZIP Code

Credit Card

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date Month Year

Security Code Cardholder Name

Credit Card Authorization*

I Accept

I authorize Fitness Formula Clubs to charge the credit card indicated in this web form for the noted amount on today’s date. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company, so long as the transaction corresponds to the terms indicated in this web form.

Name

This field is for validation purposes and should be left unchanged.

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