Welcome To The Fitness Firm - Online Member Sign Up

Selected Home Club: Front door [Club Details]


Initial Starter Plan with FMS

Membership Includes:
Meeting with our Fitness Consultant (certified in Functional Movement Assessment) to review and discover your goals, obstacles and current lifestyle to determine the best possible plan to getting you improved and optimal health.

Additional Information:
Included in this session are 5 main areas of focus:
(1) Current fitness profile & history
(2) Body Composition
(3) Resting Heart Rate & Resting Blood Pressure
(4) Cardiovascular and Strength Testing
(5) Functional Movement Screen



MEMBERSHIP BREAKDOWN
Initial Payment
Membership
$35.00
Taxes
$4.55
Amount due now:
$39.55

MEMBER INFORMATION
 
Please complete all of the following fields. You only need to enter 1 telephone contact; when entering a telephone number please enter all 10 digits without any spaces; when entering the postal code please enter all 6 characters without any spaces.
 
First Name   Last Name   Gender   Date of Birth
    Male Female  
 
Street Address   Province/State   City   Postal/ZIP   Email (Username)
       
 
Home Tel.   Mobile   Emergency Contact   Emergency Tel.   Referral Source
       
 

INITIAL PAYMENT INFORMATION
 
Card Type   Card Number  
   
 
Expiry Date   Cardholder Name   CSV [?]
   
 
Use address above for billing information
 
Street Address   Province/State
 
 
City   Postal/ZIP
 
 

OTHER MEMBERSHIP TERMS
 
Before finalizing your purchase, please carefully read the following terms and conditions.
 
 
Electronic Signature

I understand that my electronic signature below constitutes a legal signature confirming acceptance of the membership agreement.


Please sign below