Week by Week Platinum Direct Debit Wbee Application

In Balance Fitness - Week by Week Platinum

Please be informed that by submitting this form, you are completing the in-club registration process and providing us with the necessary information to manage your membership effectively. After submitting this form, you will be automatically redirected to complete the direct debit authorisation form with Debit Success, our trusted financial partner. This form will set up the necessary arrangements for your membership payments. Kindly ensure you complete both forms to avoid any delays in processing your membership.
I am over 18 years old:*

YesNo
I am Under 18 years old but over 16:*

YesNo
After completing the In Balance Fitness Club Membership form, please note that if you are under 18 years old, you will need to complete the debiting form in the club. A Parent/Guardian must act as a Guarantor for your membership. Our staff will contact you on the following business day to assist you with this process.
If you are under 16 years old, please read and acknowledge each of these conditions:*

If under 16 you must have a Parent/Guardian present with you outside of staffed hours, additionally you must have a gym induction prior to your membership commencing
Consultant*
Full name*

First NameLast Name
Birth Date*

DayMonthYear
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Important information when choosing your Membership Term: By opting for a longer membership term, you enjoy the benefits of significantly reduced rates, reflecting our commitment to rewarding your dedication to long-term fitness goals. Please be aware that selecting a specific term entails a commitment for the entire duration at the agreed-upon discounted rate. Cancelling membership during the term will incur liability for the remaining balance.

CANCELLATION

please read and check each of the following condition.
I understand that the Debit Success form is a flexi term contract, at the end of my committed payments, the membership will continue, until I choose to cancel it, and that I must fill in a cancellation form to confirm.*

I have read and understand this condition
I understand that IN CLUB cancellation takes 2 business days; alternatively email cancellation incurs 14 days' notice.*

I have read and understand this condition
SUSPENSION

please read and check each of the following condition.
I acknowledge that I can suspend the membership's payments for a fee of $2.00 per week. Also, medical suspension, supported by a doctor's certificate outlining dates and reasons, is offered free of charge.*

I have read and understand this condition
I also acknowledge that the membership freeze or hold does not reduce the total term of the membership.*

I have read and understand this condition

Please take note: All special offer prices on ADD ON purchases are exclusively valid for the initial 30 days following the commencement of your membership.
ADD ON Purchases
prevnext( X )
MyZone MZ-3 MYZONE MZ-3 Heart Rate training monitor for $119.95. Normally $139.95. Available in the first 2 weeks of membership.
$119.95AUD Quantity



The 8-Week EdgeNEW TO IN BALANCE FITNESS Option to purchase in club. The 8-Week Edge is 8 weeks of 1-on-1 personal training sessions with a personal trainer to supercharge your results. Add of $30 Per Week to any membership This is only available for purchase in the first month of any membership. Don't miss this great deal. You can also choose to purchase in club or add to your direct debit.
$240.00AUD Quantity



Friend PassAdd a friend to your first month for $29.95. Train together and stay motivated. Available to new members on sign up.
$29.95AUD Quantity



Kick Start PackEnhance your membership with 3 personalized training sessions for only $59.95. Tailored workouts, expert guidance – jumpstart your fitness journey. Unbeatable value, over 50% off standard rates. Maximize results with personal attention.
$59.95AUD Quantity



In Balance HoodieXS to XXXL
$49.95AUD Quantity



In Balance T-Shirt$29.95 Mens XS to XXXL and Ladies Sizes 8-20
$19.95AUD Quantity



Gym Induction/ProgramInvest in your fitness journey with our Induction Package. Sit down with a qualified trainer to discuss your goals and needs. Your trainer will craft a personalised program tailored to you. Learn proper technique and intensity levels as your trainer guides you through each exercise. (Already included in our Gold and Platinum memberships)
$55.95AUD



Total

$0.00AUD
Signature*

Clear
Parent/Guardian Signature*

Clear
Should be Empty:

	Yes	No
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose balance because of dizziness or do you ever lose consciousness?
Do you have bone or joint problem (for example, back, knee, or hip) that could be worsen by a change in your physical activity?
Is your doctor currently prescribing drugs (for example water pills) for your blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?

In Balance Fitness - Week by Week Platinum

EXERCISE READINESS (Par-Q)

ACCESS CARD

CANCELLATION

SUSPENSION