Membership Application Form

Membership Application

To apply for membership please complete all questions.
Name*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Glow Member ($79 monthly)Illume Member ($99 monthly)Shine Member ($49 monthly)Bronze Member (Laser hair removal $129 monthly, pick two areas)Silver Member (Laser hair removal $159 monthly, pick three areas)Gold Member (Laser hair removal $199 monthly, unlimited areas (maximum of three areas per appointment only)
Sign up fee of $79 for Glow, Illume and Shine Membership

Sign up fee of $149 for Bronze, Silver and Gold Membership
I authorize Illume Skin Spa to charge my monthly membership fee to the card that I have provided. I understand that I am in full control of my payment, and if at any time I decide to make any changes to my form of payment or membership status, I need to notify the spa by written notice at least 30 days before the renewal date.I understand that if I wish to cancel my membership, I need to notify Illume Skin Spa at least 30 business days before the renewal date (By email or letter). If I fail to do so, the membership will be renewed for the following month.I understand that I have the option to put my membership on hold two (2) times per calendar year for 30 days. A holding fee of $25 will be applied to the member per month of hold. Upon expiration of the Hold Date above, the member's account will automatically become active and payments shall resume. Member will not be able to use membership benefits during the hold period.I understand that if the payment method fails, Illume Skin Spa will try again for three consecutive days. Once the third payment fails, the membership will be automatically canceled and member will be subjected to new fees.I understand and agree that the sign up fee is not refundable.Cancellation policy still applies for monthly services. Any cancellations with less than 48 hours of notice are subject to a cancellation fee. 10 minutes late for the appointment is considered a no show and fee will be applied. Cancellation/no show fee must be paid before service is provided, otherwise monthly service will be lost.I understand that once my membership is canceled, I need to wait 6 months to enroll again.Glow/Shine/Illume/Bronze/Silver/Gold can apply 10% discount to micropigmentation or eyelash extensions.Glow/Illume/Shine members can apply 10% off towards single sessions of Laser Hair Removal. Shine members can apply 10% off towards PACKAGES of Laser Hair Removal.Bronze/Silver members have 10% off regular-price single service and 5% off in products, Gold member has 15% off regular-price single service prices and 5% off in products.Gold members (unlimited areas) will be only allowed to receive a maximum of 3 (three) treatment areas on the same day. Allowed 3 (three) areas per appointment only.To upgrade/downgrade the membership status, there will be a new enrollment fee. It can only be avoided if you have been a member (for the same membership option) for 6 months or more (except if you are upgrading to a Bronze/Silver/Gold membership).I understand that unused membership benefits cannot be applied to the following months.For Gold members, I understand that if I pay for a full year of laser hair removal and do not use all sessions, the full-year package will not be refundable.
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Signature Date*

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