Membership Application

Membership Application

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* Required fields
Name *
E-mail Address *
Address *
City *
State *
Date of Birth *
Cell Phone *
Social Security Number *
Select a Password *
Sponsor's Name *
Membership Type *	3 day bootcamp & Beginners Fitness Pak for $180/mo 5 day bootcamp & Advance Fitness Pak for $275/mo 3 day bootcamp only for $180/mo 5 day bootcamp only for $275/mo 1 day bootcamp only for $20 Weekends bootcamp only for $60 1 week bootcamp only for $80
Type of Credit Card *
Name on Card *
Cardholder Address *
City, State, Zip Code *
Email Address *
Credit Card Number
Expiration Date
Card Verification
Amount Paid
Date *
	I acknowledge and understand that Freedom By Fitness is not affiliated with any other program and I am not obligated to join other entities. Administrative fee applies to all credit card payments. *
	I hereby acknowledge that I have received materials, which may include, but not limited to application, registration, training, presentation materials, cds, dvds, brochures, booklets, business cards and supplies. I hereby authorize Freedom By Fitness, LMI and/or assigns to charge my Visa/Mastercard/American Express/Discover for the above specified amount. By signing, I confirm that I will pay for the products and services by the method specified above, below and on attached sheets. *

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