Gym Membership Request

Name *

First Name Last Name

Email *

example@example.com

Full German Address *

Apartment Number (if applicable)

Primary Phone Number *

Secondary Phone Number

Membership Type *

Single (70€ / qtr) Single (125€ / 6 mo) Single (240€ / yr) Couple (105€ / qtr) Couple (205€ / 6 mo) Couple (390€ / yr) Family (130€ / qtr) Family (255€ / 6 mo) Family (490€ / yr)

Additional members name(s) (list all please)

Desired Start Date *

Date

How would you like to receive your fob(s)? *

At my Siedlung address (noted above) Via Interoffice mail - this may cause a slight delay in when the fob is received (please note the name/office to be addressed to in "other comments" below) QuickShop at the Fieldhouse on the Siedlung At my colleague's Siedlung address (please note their name and unit/apartment info below in "other comments") N/A - I am renewing my gym membership and will be recharging my current fob(s)

Payment Type

PayPal

Other Comments

Terms and Conditions

I (we) will use the Fitness Center at my (our) own risk. I (we) will not hold the Community Support Association or the American Consulate General, Frankfurt liable for any injuries which may occur while using the Fitness Center or it’s equipment. I (we) have reviewed the rules and regulations regarding the Fitness Center and agree to abide by them to the best of my (our) understanding. I (we) accept that continued membership is contingent upon my (our) adherence to the rules and regulations of the Fitness Center.

Do you agree to the Terms and Conditions stated above? *

Yes