Chester: Flex

This plan requires 1 member with a maximum of 10 members.

How many total members would you like on this plan?

* This plan requires a minimum number of members including the primary member.

(1) Primary Member Information

First Name

M.I.

Last Name

Address 1

Address 2

City

State / Province

Zip / Postal Code

Home Phone

OK to Contact Home Phone

Preferred Phone

Home

OK to Contact Email?

Emergency Contact

Name

Phone

Birth Date

Gender

Male Female Other

Drivers License #

Did anyone at the club assist you?

State of Id

Monthly Payment

$55.00

Amount Due Today

$55.00

Service	Down Payment	Recurring	Rollover	Visits
Member 1
Dues	$55.00	$55.00	$55.00	0
Enrollment Fee	$0.00	$0.00	$0.00	0
60 Minute PT Session (1 visit)	$0.00	$0.00	$0.00	1
Member Success Plan	$0.00	$0.00	$0.00	0
Sub-Total	$55.00	$55.00
Tax	$0	$0.00
Total	$55.00	$55.00

First Monthly Payment Date: 1/2/2024

Payments will then be processed on a Monthly basis there after.

Other Fee Information

Annual Maintenance Fee (Total) of $60.00 will be billed on a Annual basis starting 2/1/2024

Payment Info

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Chester: Flex

This plan requires 1 member with a maximum of 10 members.

Monthly Payment

Amount Due Today

First Monthly Payment Date: 1/2/2024

Other Fee Information

Payment Info

Payment Info

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