Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What is your preferred training time? *

5:30am

6:30am

9am (Tues/Thurs Only)

12pm

5:30pm

6:30pm (Mon/Thurs Only)

Sat/Sun

Membership Start Date *

MM

DD

YYYY

Date of First Payment

If different to membership start date. Must be within 7 days of membership start.

MM

DD

YYYY

Bank Account Name (if different from member)

First Name

Last Name

Checkbox *

By ticking this box you agree and understand this form is for filing and set up purposes only. The membership Terms and Conditions are to be signed online (via Zen Planner) before the first class.

Agree