Club Membership Registration Form

Project Club Membership Registration

Complete the form below to sign up for our membership service.
Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Address:*

Street Address

Street Address Line 2

CityState / Province

Post Code
Birth Date:*

DayMonthYear
Terms and Conditions of Membership, please read carefully
You have chosen the Health Club Membership, which is maximum of 6 Infrared or Pressotherapy treatments in a calendar month. Which term and payment plan would you like (one Treatment is usually $49)*

12 Month Term, pay $32 weekly12 Month Term, pay $64 fortnightly12 Month Term, pay $138 monthlyOpen Term Contract, pay $38 weeklyOpen Term Contract, pay $76 fortnightlyOpen Term Contract, pay $164 monthly
Bank Account Number*
Name of Account*
Type a question*

I hereby give authority to have my direct debit set up by Project Physique via Gocardless.
Once you submit your application, we will contact you shortly to complete your membership application.

Thank you!
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