THE ALCHEMY EXCHANGE CREDIT CARD AUTHORIZATION FORM

Think of the Exchange as your personal Membership program for aesthetic care. Each month, your Membership provides you with Treatment Credit that may be applied toward eligible services and products at your preferred Member pricing. It is a simple way to enjoy ongoing access to the care you love while maximizing the value of your Membership.

This Membership Agreement (the “Agreement”) is entered into by and between The Alchemy Clinic, PLLC (the “Clinic,” “we,” “us,” or “our”), a New Hampshire corporation located at 753 Chestnut Street, Manchester, New Hampshire, and the individual identified below (the “Member,” “you,” or “your”). This Agreement governs your enrollment in The Alchemy Exchange Membership Program (the “Program”).

• $200 deposited monthly as treatment credit
• Preferred pricing on injectables, regenerative treatments, lasers, energy based procedures, and eligible treatment protocols
• Priority scheduling, with early access to our most requested appointment times
• Quarterly members only Tox Days at $13 per unit. Appointments are limited
• Ten percent savings on medical grade skincare and supplements, and twenty percent on ZO® Skin Health products purchased as part of a Signature Protocol
• Exclusive monthly member offers
• Early access to new treatments, technology, and product launches
• Invitations to educational events and model opportunities
• Access to The Alchemy Collective