Application for Membership AgreementApplication for Membership Agreement • January 28th, 2019
PERSONAL INFORMATION Name(s): Birthdate(s): Street Address: City: State/Zip: Billing Address (if different than street address above): City: State/Zip: Email: Cell Phone: Home Phone: How did you hear about The Lab? Adult Programs (16 years and older) Jiu Jitsu ($xxx/month) Karate ($xxx/month) Children’s Programs (4-15 years) Jiu Jitsu ($xxx/month) Karate ($xxx/month) After School Program ($xxx/month) 12-Month Membership, Monthly Payments (rates above) 12-Month Membership, Quarterly (every 3 months) Payments (10% discount) 1-Month Introductory Membership (10% discount-one time only) Family Discount (10% off memberships for two members in the same household, 25% off for three or more members in the same household) Multiple Programs Discount (10% off for multiple programs for a single member)
