949 Powerlifting Membership Enrollment Form
Complete this form to apply for 24/7 access to 949 Powerlifting Gym in Lebanon, IL. Membership fees are billed monthly and are due on the 1st of each month. A 30-day written notice is required to cancel your membership. If you cancel before the end of your contract term, a $150.00 early termination fee will apply. A $10.00 late fee will be applied for any payment not received by the due date. All members must be 18 years of age or older. Those under the age of 18 years old are not permitted in the gym (unless they are accompanied by a 949 trainer). By submitting this form, you acknowledge that you have read and understand the membership terms and conditions.
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Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email (DOOR CODE WILL BE SENT TO YOUR EMAIL ONCE FORM IS SUBMITTED)
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example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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File Upload
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Emergancy Contact
Name
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Relationship
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Membership Selection
Select which membership you would like. Active military, veteran's and students get 20% off membership!
Single Membership (Primary Membership)
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6 Month Contract: Billed at $60.00 per month
12 Month Contract: Billed at $50.00 per month
Month to Month: Billed at $75.00 per month
Multiple Household Membership (Secondary Membership)(Includes one person). NOTE: Additional household members understand they agree to all membership terms and conditions once their ID is uploaded. It is the primary members responsibility to make sure all household members follow gym terms and conditions.
6 Month Contract: Billed at $50.00 per month ($110.00 per month total including primary membership)
12 Month Contract: Billed at $40.00 per month ($90.00 per month total including primary membership)
Month to Month: Billed at $65.00 per month ($140.00 per month total including primary membership)
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Do you need to add more than one additional membership to your household? (Reminder: all members must be 18 years or older)
Yes - one more (three total memberships) (additional $50.00 per month for 6 month contract, additional $40.00 per month for 12 month contract, additional $65.00 per month for month to month)
Yes - two more (four total memberships) (additional $50.00 per month for 6 month contract, additional $40.00 per month for 12 month contract, additional $65.00 per month for month to month)
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Are you active military or a veteran?
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Yes
No
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Are you a student?
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Yes
No
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Debit/Credit Card
An electronic payment made using a debit card or credit card to purchase goods or services.
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Billing Zip Code
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Membership Terms
By signing this agreement, I acknowledge and agree to the following: Membership dues are billed on the 1st day of each month. A 30-day written notice is required to cancel my membership. If I cancel my membership before the end of my selected contract term, I agree to pay an Early Termination Fee of $150.00. A $10.00 late fee will be charged for payments not received by the due date. Memberships are non-transferable. Membership rates are guaranteed for the duration of the signed agreement. Failure to make payments may result in suspension or termination of membership privileges. 949 Powerlifting reserves the right to revoke membership for failure to comply with gym rules, unsafe behavior, harassment, destruction of property, illegal activity, or non-payment.
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I have read and agreed to the terms and conditions stated above
24/7 Facility Access
Members receiving 24/7 access understand and agree that: Access credentials are for the member's personal use only. Sharing access codes, key fobs, or allowing unauthorized individuals into the facility is strictly prohibited. Unauthorized access may result in immediate termination of membership without refund. Members are responsible for securing the facility upon entry and exit. Members must report any damaged equipment or unsafe conditions immediately. To help maintain a safe and secure environment for all members, 949 Powerlifting utilizes 24/7 video surveillance throughout the facility. Security cameras are installed in common areas of the gym to help protect members, staff, equipment, and property.
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I have read and agreed to the terms and conditions stated above
Gym Rules
Members agree to: Respect all members, guests, and staff. Wipe down equipment after use. Return weights and equipment to designated locations. Use equipment properly. Wear appropriate athletic clothing and closed-toe athletic shoes. No drugs, alcohol, smoking, or vaping inside the facility. No abusive, threatening, or disruptive behavior. Follow all posted safety instructions. Failure to follow gym policies may result in suspension or termination of membership
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I have read and agreed to the terms and conditions stated above
Assumption of Risk
I certify that I am physically able to participate in strength training and exercise activities. I understand that if I have any medical concerns or health conditions, I should consult my physician before participating in any exercise program. I agree to immediately discontinue exercise if I experience dizziness, chest pain, shortness of breath, or any other concerning symptoms. I understand that participation in weightlifting, powerlifting, strength training, cardiovascular exercise, and other physical activities involves inherent risks, including but not limited to: Muscle, strains, Sprains, Broken bones, Back injuries, Head injuries, Heart attack, Stroke, Paralysis, Permanent disability, Death. I voluntarily assume all risks associated with participating in activities at 949 Powerlifting. In consideration of being allowed to participate in activities at 949 Powerlifting, I hereby release, waive, discharge, and hold harmless: 949 Powerlifting, Its owners, Employees, Coaches, Trainers, Volunteers, Independent contractors, Representatives from any and all liability, claims, demands, actions, damages, costs, or expenses arising from injury, illness, property damage, disability, or death resulting from my participation, except where prohibited by applicable law.
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I have read and agreed to the terms and conditions stated above
Property
Members are financially responsible for damage caused through intentional misuse, negligence, or reckless conduct. 949 Powerlifting is not responsible for lost, stolen, or damaged personal belongings. Members are encouraged to secure valuables.
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I have read and agreed to the terms and conditions stated above
By Signing the below, I agree to all terms and conditions of this agreement.
Signature
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