New Membership Application

New Membership:

First Name:

Last Name:

Gender:

DOB:

Email Address:

Mobile Phone:

Address:

Suburb:

State:

Post code:

How did you find us?:

 

Membership Type:


BasicPlatinum

 

Debit Details:

Account Name:

BSB:

Account #:

Re enter Account #:

Supported Cards:

Name on Card:

Card Number:

Expiry Date:

Please Note***

Payments will be deducted on Wednesdays each week.
Fee Structure per transaction:

Visa/ Mastercard: $0.33 + 1.98%
Bank account: $0.33c
Signup Fee: $2.20 (one off)
Dishonour Fee: $3.30 each time

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*** By clicking Submit, You are agreeing to the both the payment terms and schedule outlined, plus the terms and conditions here: http://enterfitness.com.au/terms-and-conditions1/