Membership Application Form

Spa Utopia Member Application
Name *

First Name Last Name
Date *

Month Day Year
Sex *

Female Male
Email *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Primary Phone Number *

Area Code Phone Number
Occupation *
Driver's License State & Number *
LinkedIn Profile URL
Photograph Verification

Please upload your photo below.
Describe any problem areas for massage therapy *
Please Read, Check & Sign Below *

***I agree that the conduct on both parties (named the client & therapist) shall be professional at all times and void of any sexual references and suggestions. Shall either party be suggestive in this manner; the massage may be ended immediately. If the behavior is exhibited by the client full payment will still be required and this incident will be reported to the establishment’s management and security. If the behavior is exhibited by the spa contractor full payment will still be refunded and the said contractor will not be paid.
Signature field *
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Spa Utopia Member Application