Gym Membership Form

Gym Membership Form

Please complete this form to formalize your membership agreement with our gym.
Member Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Membership Start Date*

MonthDayYear
Date
Membership Type*

Monthly $69 plus tax auto renewalAnnual $49 plus tax yearly contract
Emergency Contact Name*
Emergency Contact Phone Number*
Please enter a valid phone number.
Member Signature (Please sign below to confirm your agreement to the contract terms)*

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MEMBERSHIP
I UNDERSTAND THAT AFTER MY MEMBERSHIP TERM I SELECTED (Annually or monthly) , I WILL STILL BE DRAFTED ON A MONTH BY MONTH BASIS UNTIL I SIGN A CANCELLATION FORM

AUTHORIZE DRAFT
I authorize Lopez Rentals LLC/ DBA Next Level Gym to charge my bank account for the package membership I have chosen on the first day of every month for 12 consecutive months. After one year the payments will continue unless a cancel contract form is filled out to stop payment by no later than the 15th of the month. I agree to not cancel membership for 1 year and understand i will be sent to collections if i do cancel.
I Understand and Agree

RETURN FEES AND RULES
Any return payments will be charged an additional $25 for a return check fee and i agree to the terms and conditions. To get out of this contract, 90% of remaining contract value has to be submitted along with a cancellation form. I understand nonpayment can be sent to collection at any time. I also agree to not dispute this recurring bill with my bank so long as the transactions correspond to the terms indicated in this authorization form. THIS IS A NON-TRANSFERABLE CONTRACT. *****I DO UNDERSTAND THAT MY GYM MEMBERSHIP IS ONLY FOR ME AND IF I LET ANYONE IN ON MY VIZPIN ACCOUNT OR OPEN THE DOOR FOR SOMEONE I WILL AUTOMATICALLY LOSE ACCESS TO THE 24 HOURS AND HAVE TO COME PAY A $30 REINSTATEMENT FEE TO GET 24 HOUR ACCESS AGAIN**** ANY QUESTIONS CALL OWNER MELODY LOPEZ 870-758-0295

I have read and understood the foregoing assumption of risk, and release of liability and I understand that by signing it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission. I understand that by signing this form I am waiving valuable legal rights.
Signature

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