AUCC Member Form

AUCC Member Form

Fill out the form carefully
$0 DOWN

NO SIGN UP FEES
NO REGISTRATION FEES
NO CANCELLATION FEES
30 Day Cancellation Notice Required

OPEN 7 DAYS A WEEK
5AM TO 10PM

Check out out virtual tour - https://youtu.be/4jiCIiEzi5I

STATE OF THE ART FITNESS FACILITY, MARTIAL ARTS,
SELF DEFENSE, FITNESS & YOUTH CLASSES

FAMILY GYM (CO-ED)

WOMEN ONLY FLOOR

GORILLA CAMP (MEN ONLY)

& MUCH MORE!!

JOIN AUCC💪🏽

55 HILLSIDE AVE
TEANECK NJ
Member Name 1*

First NameLast Name
Member Name 2 (if applicable)

First NameLast Name
Birth Date*

MonthDayYear
Birth Date (if applicable)

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Mobile Number*
Child 1 Name (if applicable)

First NameLast Name
Child 1 Birth Date (if applicable)

MonthDayYear
Child 2 Name (if applicable)

First NameLast Name
Child 2 Birth Date (if applicable)

MonthDayYear
Child 3 Name (if applicable)

First NameLast Name
Child 3 Birth Date (if applicable)

MonthDayYear
Child 4 Name (if applicable)

First NameLast Name
Child 4 Birth Date (if applicable)

MonthDayYear
Referral
Name of person who referred you
AUCC Memberships*
prevnext( X )
Platinum GymGym Membership including All Fitness Classes
$49.99 Quantity



PlatinumMonday to Friday Youth Programs
$100.00



Platinum (Sibling Discount)Monday to Friday Youth Programs
$90.00 Quantity



Saturday CampSaturday Only (10am to 2pm)
$125.00



Saturday Camp (Sibling Discount)Saturday Only (10am to 2pm)
$112.50 Quantity



Total

$0.00
I attest that the above information is correct. I attested that I and additional members of household are in good health and in the event of a medical emergency, I authorize AUCC to seek emergency medical care as deemed necessary by director. I attest that I will be photographed and/or recorded while at AUCC, which may be displayed via internet, newsletter, or advertisement. I authorize AUCC's Masjid Al'Nuha to charge congregational dues at the beginning of every month as stated above. Cancellation Notice is required via email at a minimum of 30 days prior to charge. By signing this form, I hereby acknowledge and understand that AUCC as well as all other associated amenities such as Ray of Sunshine Foundation, staff, volunteers, affiliates, and board members, will not be held accountable in the case of illness, injury, death, and damage to personal property sustained to myself or any minors included on this form, while on the premise, located 55 Hillside Avenue, Teaneck, NJ.
Signature*

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No Refunds, Email MasjidAlNuha@AUCCnj.org with any questions!

Payment Methods

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First Name

Last Name

Credit Card Number

Security Code

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