the MODERN Society Membership Agreement

The MODERN Society Membership

The Modern Society Membership is designed to give you a taste of luxury, all while rewarding our most loyal patients with incredible monthly savings. The Modern Society Members enjoy an exceptional value, along with privileges and benefits that are exclusive for the Modern Society Members. Each month as a member, you will be able to take advantage of the options listed below.

The MODERN SOCIETY Membership - $25 – Per Month

- 10 % Off Neurotoxins

- 10 % Off Fillers

- 10% Off Spa Services*

- 10% off Skincare Products

- Access to exclusive offers and flash sales

- Annual Complimentary Consultation with Visia analysis to update treatment plan on membership anniversary

The MODERN Society Membership Terms & Agreement

At MODERN Plastic Surgery & Medspa, we strive to provide the best possible service to our patients, which is why we ask you to keep a few simple policies in mind.

Appointment Cancellation Policy
We kindly request that you provide at least 24 hours' notice if you need to cancel or reschedule your appointment. A $75 fee will be applied for cancellations made with less than 24 hours' notice.

Membership Terms
Memberships, benefits, and complimentary services are non-transferable and non-refundable. Participation in the MODERN Society Membership Program requires a valid credit card and email address on file. A $25 monthly fee will be charged to your card, starting on the date of your initial setup, and will continue until membership termination. You may change your monthly charge date upon request.

The MODERN Plastic Surgery & Medspa reserves the right to modify the terms and conditions of the MODERN Society Membership Program with prior written notice.

Membership Commitment & Termination
The MODERN Society Membership requires a minimum 6-month commitment. To terminate your membership, we require a written notice 30 days in advance, signed by all parties associated with the membership.

Sales & Promotions
All MODERN Society Membership sales are final. Membership benefits cannot be combined with other current Medspa promotions, and we do not offer upgrades or exchanges for services.

*Does not apply to Weight Management Program

Name*

Primary Phone*

Email Address*

example@example.com

Membership Type & Payment Schedule:

Agreement Start Date*

Date

1. Your membership dues will be due every month in the amount of $25 until your membership is terminated in accordance the terms and agreement. Your obligation to pay membership dues is not dependent upon your usage of The MODERN Plastic Surgery & Medspa locations or availability of a specific service provider.

(Member Initials)*

2. Your membership must be in current status to utilize the full benefits of your membership.

(Member Initials)*

3. Your membership will automatically be renewed at the end of the monthly term unless you submitted a (30) day written notice to terminate your membership before your next scheduled payment is required.

(Member Initials) *

4. Your membership may not be applicable with other current office promotions. *May be used in conjunction with Alle & Aspire *

(Member Initials) *

By signing below, I authorize The MODERN Plastic Surgery & Medspa to complete an electronic fund transfer (charge) from my credit card as listed below. The monthly dues will be withdrawn on the day of initial setup every month. I understand that The MODERN Plastic Surgery & Medspa will continue to charge my account until I cancel my membership in accordance with the terms and conditions of this agreement and that any membership status change request must be submitted in writing via email (ashley@themodernnola.com), or within (30) days to 3100 Galleria Dr. Suite 205 Metairie LA, 70001.

Name as shown on Credit Card*

Credit Card Type *

Last 4 Digits*

Expiration Date*

Date

Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

I am at least 18 years of age and wish to enter this agreement with The MODERN Plastic Surgery & Medspa to obtain the MODERN Society Membership. I understand that this membership will not be effective until this General Terms Agreement has been executed and all its terms have been complied with. By providing an email address & phone number, I expressively consent to receive email & text messages regarding various products to the payment schedule shown above. If you agree to bound by the general terms and of the MODERN Society Membership agreement, please sign your name below.

By signing below, you acknowledge reading and accepting this general membership agreement terms and conditions.

***For your security, a staff member will call you to verify your card details prior to activating your membership.***

Member Signature*

Date*

Date