Oasis Membership Registration Form

Name*

First NameLast Name

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

Phone Number:*

Area CodePhone Number

Memberships Tiers

VIP Tier 1$139.00

6 month commitment includes: 1 saline bag with 4 compounds of your choice per month. Receive 20% discount on retail drips, 50% discount on IM, 50% discount for add-ons *$150 early cancellation fee

VIP Tier 2$69.00

6 month commitment includes: 1 saline bag with 2 compounds of your choice Receive 10% discount on retail drips, 50% discount on IM, 50% discount for add-ons *$150 early cancellation fee

Total $0.00

Credit Card

Thank you for filling out your membership form! Your are just one step closer to enjoying your Oasis Membership Beneftis! Once we recieve your payment, your Oasis Membership will be active and ready to enjoy.

Thank you!

~Oasis Staff