Student Name *

First Name

Last Name

Membership

Adults Weekly ($40/wk)

Teens Weekly ($35/wk)

Direct Debit Account Details: *

First Name

Last Name

Direct Debit Payments To Be Taken From The Provided Account:

Please contact us via email or 0418 806 282 if required

Agree

I have read and agree to the indemnity waiver

Indemnity waivers are available from the gym for review. Please ensure you have read and agree prior to training.

Yes

I understand there is a 30 day notification requirement to cancel

Agree