Regenerative Collective Private Membership Association (PMA) Membership Application & Agreement

Join Regenerative Collective

Gain immediate access to our curated collection of regenerative wellness products, medical concierge programs, and member pricing. Membership is activated upon completion.
Private Membership Association (PMA) Membership Application & Agreement
Member Information
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*

Confirmation EmailPlease use the email you will log in with. Access instructions will be sent to this address.
Membership Terms
By signing below, I acknowledge and agree:
1. I am voluntarily joining the Regenerative Collective, a Private Membership Association ("PMA").
2. I understand this is a private, contractual agreement between myself and the Association, and not open to the general public.
3. Services provided may include aesthetics consulting, skincare education, wellness support, and related private services.
4. I understand these services are for members only, are not a substitute for licensed medical care, and I accept full responsibility for my choices as a member.
5. I release, waive, and hold harmless the Association, its trustees, officers, and representatives from any claims arising from my participation.
6. I agree to respect the confidentiality of Association activities and materials.
7. I understand membership may be terminated for non-payment, misconduct, or violation of this agreement.
Member Signature*
Fees
Membership Fee: One time fee of $129.00
Service Fees: To be agreed upon prior to service.
Acknowledgment

By signing this application, I confirm that I have read, understood, and voluntarily agree to the terms of this Membership Agreement.
Member Name*

First NameLast Name
Member Signature*
Date*

MonthDayYear
Date
Association Trustee/Representative

First NameLast Name
Association Trustee/Representative Signature
Date

MonthDayYear
Date

Payment for Regenerative Collective Membership*

Regenerative Collective Membership

$129.00 membership fee

$129.00

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Should be Empty:

Join Regenerative Collective

Private Membership Association (PMA) Membership Application & Agreement

Member Information

Membership Terms

Fees

Acknowledgment

Payment Methods