Ultimate Membership

1
Main membership holder/ Member #1* This field is required.Please enter the name of the main membership holder. Must be 18+ to be main membership holder
First Name
Last Name
DOB MM/DD/YYYY
2
Email* This field is required.Enter the email associated with your community fieldhouse account. If you do not already have one, please enter the email you'd like to create an account with.
example@example.com
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification
••••
Didn't receive verification code?or
Receiving the email may take a few minutes, thank you for your patience!
3
Phone Number* This field is required.Main members phone
Please enter a valid phone number.
4
State Photo ID required for main membership holder* This field is required.
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Max. file size: 10.6MB
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5
Member Photo* This field is required.Please upload a headshot of member. Members without photos will not be approved. Be sure this is a clear photo with only the member in it.
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Max. file size: 10.6MB
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6
Member #2* This field is required.Enter member 2 information. This must be a household family member. Extended family or friends will not be approved.
First Name
Last Name
DOB MM/DD/YYYY
7
Member #2 Photo* This field is required.Please upload a headshot of member #2. Members without photos will not be approved. Be sure this is a clear photo with only the member in it.
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Select files to upload
Max. file size: 10.6MB
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8
Member #3* This field is required.Enter member 3 information. This must be a household family member. Extended family or friends will not be approved.
First Name
Last Name
DOB MM/DD/YYYY
9
Member #3 Photo* This field is required.Please upload a headshot of member #3. Members without photos will not be approved. Be sure this is a clear photo with only the member in it.
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Select files to upload
Max. file size: 10.6MB
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10
Member #4* This field is required.Enter Member 4 information. This must be a household family member. Extended family or friends will not be approved.
First Name
Last Name
DOB MM/DD/YYYY
11
Member #4 Photo* This field is required.Please upload a headshot of member #4. Members without photos will not be approved. Be sure this is a clear photo with only the member in it.
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Select files to upload
Max. file size: 10.6MB
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12
Member #5* This field is required.Enter Member 5 information. This must be a household family member. Extended family or friends will not be approved.
First Name
Last Name
DOB MM/DD/YYYY
13
Member #5 Photo* This field is required.Please upload a headshot of member #5. Members without photos will not be approved. Be sure this is a clear photo with only the member in it.
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Select files to upload
Max. file size: 10.6MB
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14
Member #6* This field is required.Enter Member 6 information. This must be a household family member. Extended family or friends will not be approved.
First Name
Last Name
DOB MM/DD/YYYY
15
Member #6 Photo* This field is required.Please upload a headshot of member #6. Members without photos will not be approved. Be sure this is a clear photo with only the member in it.
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Select files to upload
Max. file size: 10.6MB
Cancelof
16
Member #7* This field is required.Enter Member 7 information. This must be a household family member. Extended family or friends will not be approved.
First Name
Last Name
DOB MM/DD/YYYY
17
Member #7 Photo* This field is required.Please upload a headshot of member #7. Members without photos will not be approved. Be sure this is a clear photo with only the member in it.
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Select files to upload
Max. file size: 10.6MB
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18
Member #8* This field is required.Enter Member 8 information. This must be a household family member. Extended family or friends will not be approved.
First Name
Last Name
DOB MM/DD/YYYY
19
Member #8 Photo* This field is required.Please upload a headshot of member #8. Members without photos will not be approved. Be sure this is a clear photo with only the member in it.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
20
Member #9* This field is required.Enter Member 8 information. This must be a household family member. Extended family or friends will not be approved.
First Name
Last Name
DOB MM/DD/YYYY
21
Member #9 Photo* This field is required.Please upload a headshot of member #9. Members without photos will not be approved. Be sure this is a clear photo with only the member in it.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
22
Signature* This field is required.Please sign that you agree all information is true and you understand this membership is for direct household family members only. We reserve the right to suspend or cancel the membership at any time for any reason. If membership is cancelled due to breach of contract no refunds will be given. Members are not able to be removed, added or changed without submitting a request and membership manager approval. This membership is a 3 MONTH AGREEMENT and then continues as a month to month. After the initial 3 months you may cancel at anytime by contacting Membership Manager: Andy Benear andy@communityfieldhouse.com or submitting a membership request on your account. *MEMBERSHIPS FOR IMMEDIATE FAMILY ONLY. YOU MAY BE ASKED TO PROVIDE IDENTIFACATION AND PROOF OF MATCHING HOME ADDRESS. Cousins, nephews, nieces etc. are not included.*
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