Fitness Point

Fitness Point, LLC 112 Fountain St. Mineral Point, Wis 53530					Membership Agreement Date:__________________Staff_____________________
Billing Person Name:__________________________________ Referred By:_____________________________ Address:_____________________________________ City:________________________ State______ Zip_______ Home Phone:_______________________ Work Phone:_______________ Cell Phone:____________________ Email Address:_________________________________________________________________________________
Please Select Type of Membership Desired
Individual	Couple	Ind. + Children	Family	Senior	Senior Couple	Student	Business	Other

Persons Included In Membership
Name		DOB	Key	Picture	Gift	Tour	Misc.	Other





Membership Payment Plans
Enrollment Fee …………….... 1st Month or Annual Fee …….			$ 50.00 $ _______________		Method of Payment: □ Cash □ Check □ Credit Card
Amount Paid w/ contract .................... Monthly Dues ......................................			$ _______________ $ ________________		Membership Term: ________________________ Membership Dates: __________to ____________
Monthly Payments or Prepayment (Check the Box A or B below)
A.	I desire convenience, control and privacy for payment of my membership dues. I request my monthly dues be charged directly to my bank or credit card as checked below. Enrollment fee and 1st month’s prorated dues are made payable to Fitness Point and must accompany this application. Note: Application for checking or savings accounts monthly dues cannot be processed unless a voided check or deposit slip, which has your account number or routing number visible on it, is attached. Please select desired method below: □ Checking □ Savings □ Credit Card □ 12 months___Self-Renewing □ 24 months ____Self-Renewing Starting Date: __________/__________/_________ Comes out on the 10th of every month! Monthly dues will be made on the 10th of the month, I understand that I do not have to write a check for my dues and that there is no extra charge for this service. Fee for canceling membership terms before contract date is $150. No fee for reaching your term date. Self-renewing memberships can be cancelled with 1 month notice with no fee after term date. Applicant’s Signature: _________________________________ Date:______________________
B.	I select to pay in FULL. I understand that the membership is NOT self-renewing and to keep my current rate and not be assessed an additional enrollment fee, I must renew prior to my expiration date. Applicant’s Signature: _______________________________Date:_______________________ Co-Applicant’s Signature: ____________________________Date: ______________________

Bank Draft Contract Terms

I have received and read the “Policies and Procedures” document. By signing this contract I agree and understand the terms as described in that document and know that, after three (3) days of signing that contract, I may no longer terminate my membership, until it comes due, without paying an early termination fee of $150.00.

Termination of a contract due to disability (need doctor’s written excuse) or relocation (need proof of new residence farther than twenty (20) miles away from Fitness Point) will be worked out between the member and “Fitness Point” staff.

Signature:_______________________________________Date:___________________

Membership Agreement