MEMBERSHIP AGREEMENT FORM 

Please fill out the form below to set up your membership.

MEMBERSHIP INFORMATION
Name *
Name
Please choose your membership option *
Please choose your start date *
Please choose your start date
Please enter which day you are starting your membership. Please note that all memberships start on the first of the month. If you are starting in the middle of the month your membership will be pro-rated until the first day of the following month.
I agree to to the terms and conditions below
1. All memberships will auto-renew on the 1st day of each month unless canceled by me. Auto-renewals will be at the current price, terms, and conditions at the time of auto-renewal. A copy of the current membership agreement is available on request. 2. Membership fees will be paid by pre-authorized payment and are subject to change without notice. Membership fees overdue are subject to interest charges of 1% per month. 3. When making a change to or canceling a membership, notice of one (1) month prior to the upcoming month is required. For example, changing your membership as of December 1 would require notice of the change on or before October 31. Notice of a change to a membership must be made using the Membership Change form supplied by SYNERGY. I must contact SYNERGY for this form. No other method of notice will be accepted. 4. For a Couples membership, a Couple is defined as two married people or two people cohabiting at the same address. 5. For a Family membership, a Family is defined as i) comprised of 2 spouses/partners and 1 or more children under the age of 18 years or ii) comprised of 1 parent and 2 or more children under the age of 18 years. 6. For a Student membership, valid student identification as a full-time student is required. 7. The Emergency Services membership is a 1 year non-cancellable, non-refundable contract. 8. The Unlimited Annual membership is a 1 year non-cancellable, non-refundable contract. 9. Personal training and nutrition sessions are non-refundable and expire 1 year from date of purchase. If I do not appear for a scheduled appointment or fail to give 24 hours cancellation notice, I will be charged for the full session. 10. I agree to follow any SYNERGY membership policies and rules which may be posted at the facility, on-line or issued orally. SYNERGY may, in its sole discretion, modify its membership policies and rules without notice at any time. I agree that improper unauthorized use of the facility may result in membership cancellation or suspension. SYNERGY may suspend or cancel the rights, privileges, and membership of any member whose actions are detrimental to the enjoyment of the facilities by other members or for failure to comply with membership policies and rules. 11. I consent to receive email and other forms of communications from SYNERGY. 12. I understand that SYNERGY is not responsible for any of my personal property that is damaged, lost or stolen while in or around the facility. I understand and agree that I am liable for all damage I cause to the equipment or physical infrastructure of the facility and will reimburse SYNERGY for any damage I cause. AUTHORIZATION I have read and understood this.
BILLING INFORMATION:
Choose Credit Card or Pre-Authorized Debit Transactions (options below)
**CREDIT CARD
Please enter your credit card number
As written/stated on Credit Card
Please indicate your billing address for your Credit Card.
Please enter your expiration date
Please enter your CVV
**PRE-AUTHORIZED DEBIT
If you would like to use your bank account for your membership please fill in the information below. If you are using a credit card please void this section.
Please check this box if you do not feel comfortable submitting your billing information online and we will contact you with other options
FAMILY/COUPLES MEMBERSHIPS
If you have chosen either a couples or family membership, please enter the names of all members included in this membership:
If you have chosen either a couples or family membership, please enter the names of all members included in this membership:
Member 1
Member 2 (Couples or Family)
Member 2 (Couples or Family)
Member 3 (Family)
Member 3 (Family)
Member 4 (Family)
Member 4 (Family)
 
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