Fitness Point, LLC
112 Fountain St. Mineral Point, WI 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
Ind. + Children
Couple
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 due 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    □ 24 months

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. I understand the membership is not self-renewing and to keep my current rate and not be assessed an additional fee, I must renew prior to my expiration 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: ______________