2022 Membership Sign UpMembership Plan- Select -Paid in advance - 1 MonthPaid in advance - 3 MonthsPaid in advance - 6 MonthsPaid in advance - 12 monthsEasy Pay AnnualEasy Pay ActiveEasy Pay FlexiTitle- Select -MrMrsMissMsFirst NameMiddle NameLast NameStreet Name & NumberSuburbCity/TownPost CodeHome PhoneWork PhoneMobile PhoneWould you prefer us to communicate with you by Email TextDate of birthEmailYour Doctor (used for emergencies only)Emergency Contact PersonPhoneAny medical conditions affecting your workoutsA close relative or friend (not living with you)Their Phone Your Employment Details: (if you are a student please record your school, or place of learning)OccupationEmployerWork PhoneAvailable freezes: [Total - 3months] per 12month periodFreezes: During the initial term you can suspend your membership and your payments asset out in the agreement. Each freeze must be for at least 1month/4 weeks. Your Initial Period will beextended by the length of freezes. After the minimum term you can suspend your membership by amaximum of 3 months in any period of 12 months of centre use. A freezing administration fee will apply. Ifyou use the centre during a freeze period, you must restart your payments immediately. I I have read and agree to the above Freezes PolicyWhen payment(s) are missed, you may not be able to enter the centre until you have paid any overduebalance. All costs associated with recovery of any missed payments will be added to any amounts due. Thisincludes a $20 administration charge, and all reasonable collection agency costs. I have read and agree to the above Missed Payments PolicyFacility rules and procedures: You must always comply with the rules and procedures while using thecentre. I have read and agree to the above Rules PolicyTermination by us: we may terminate your membership immediately if you carry out any activity which wereasonably consider to be illegal, offensive, dangerous to other people or to you, if you act in serious breachof facility rules, or if at any time four or more payments are overdue. If we terminate because of your actions,we will not be liable to you in any wayAre you over 18 years of age Yes NoName of parent or legal guardianPhoneSubmit Form