Club Membership Registration Form

Project Club Membership Registration

Complete the form below to sign up for our membership service.
Name

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Address:

Street Address

Street Address Line 2

CityState / Province

Post Code
Birth Date:

DayMonthYear
Terms and Conditions of Membership, please read carefully
You have chosen the Maintain Membership, which is maximum of 4 body treatments in a calendar month. Which term and payment plan would you like (one Treatment is usually $60 - $65!)
prevnext( X )
12 Month Term($41.00 NZD for each week)

12 Month Term($82.00 NZD for each two weeks)

12 Month Term($177.00 NZD for each month)

Open Term($51.00 NZD for each week)

Open Term($102.00 NZD for each two weeks)

Open Term($216.00 NZD for each month)
Details for Direct Debit Payments
Bank Account Number
Name of Account
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