Club Membership Registration Form

Project Club Membership Registration

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

First Name Last Name
E-mail *
Phone Number *

Area Code Phone Number
Address: *

Street Address

Street Address Line 2

City

Post Code
Birth Date: *

Day Month Year
Terms and Conditions of Membership, please read carefully
You have chosen the Restore Membership, which is maximum of 6 body treatments in a calendar month. Which term and payment plan would you like (one Treatment is usually $65!) *
prev next ( X )
12 Month Term - weekly ( $ 52.00 NZD for each week )

12 Month Term ( $ 104.00 NZD for each two weeks )

12 Month Term ( $ 225.00 NZD for each month )

Open Term ( $ 60.00 NZD for each week )

Open Term ( $ 120.00 NZD for each two weeks )

Open Term ( $ 260.00 NZD for each month )
Direct Debit payment details:
Bank Account
Name of Account
*

I hereby give authority to have my direct debit set up by Project Physique via Gocardless.
Thanks for filling out this form, your application will be processed shortly.
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