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Dr/Mr/Mrs/Ms
Dr
Mr
Mrs
Ms
First Name
Surname
Postal Address
Postal Code
I.D No
Tel number (work)
Tel number (home)
Tel number (cell)
Medical Allments
Medical Aid Scheme
Email
Occupation
Employer
Please upload a copy of you ID/Passport
In case of an emergency (Relative not living with you)
First Name
Surname
Tel No. (H)
Tel No. (W)
Tel No. (C)
Membership Details
Membership Type
Gym
Squash
Sunbed
Spa
Other
Start Date
Payment Details
Membership Fee
12 Month Gym Membership R439/month
24 Month Gym Membership R389/month
36 Month Gym Membership R339/month
Joining Fee
Joining Fee R300
Tag Fee
Tag Fee R200
Card
Debit Card
Credit Card
Card Number
Card Expiry Date
CVC No
1.
It is expressly recorded and agreed that in the event of the member paying the fees and charges referred to herein by credit card the cardholder's bankers are acting as agent for the cardholder in effecting payment to the (Pty) Ltd in regard to any amount of any nature whatsoever claimed by the bank from the cardholder arising out of such payment to the (Pty) Ltd.
2.
The fees and charges quoted by the (Pty) Ltd and/or stipulated on the face hereof to the Member do not include any interest or other charges which may be charged against the cardholder by his/her bankers arising out of the use of the credit card in this transaction.
3.
The monthly payments quoted by the cardholders bankers or by the (Pty) Ltd over a given pay back period on the cardholder's budget account on the credit card may change due to the cardholder's banker's insistence upon a shorter pay back period on the budget account.
4.
In the event of the cardholder's bank having paid the )Pty) Ltd the total amount of the fees refferef to on the face of hereof then all monies payable on a monthly basis on the cardholders budget credit card acoing arising out of this transaction are owed to the bank. and not to the (Pty) Ltd.
Debit Order
Bank Name
Branch Name
Account Holders Name
Branch Code
Acc/Card No.
Type
Savings
Current
Transmission
Master
Visa
Membership Acceptance
Acceptance
I, the undersigned hereby confirm that the information provided by me and contained in this membership agreement is correct and that I have read, understood and accept the terms & conditions which can be found here. I accept that this membership agreement may not be cancelled by me except on valid legal grounds. Please click here for the terms and conditions of membership.
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