Membership Form:
Membership Start Date:   Membership Expiry Date:  
Membership Term
Monthly:    6 Month:    Annual:   
Name:
First Name:  

Surname:

Date of Birth:  

 
Gender:
Male:    Female:   
Address:
Full Address:
Contact Information

Primary Contact Information:

Email Address:

Emergency ContactNumber:
Additional Information

How did you find out about Total Health Zone?
Word of Mouth:      Press/Brochure:    Internet/Email:     Other Channels:  

Have you used a Gym before?
Yes:    No:
Membership Fees

I agree to pay the following fees:    Joining Fee $

Gym Subscription
Monthly:    6 Month:    Annual:   

 Fee: $

TOTAL FEE: $

Signature: Date:  

Declaration

Before signing this document, I have read, understand and hereby agree to the terms and conditions of Membership, and acknowledge that it may affect my legal rights.

Signature: Date:  

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