Martial Arts World & Fitness Center Membership Agreement

Primary Member

The responsible party for this agreement. Must be 18+ to fill out this section.

First Name *

Last Name *

D.O.B. * +

SSN *

DLN

Street Address *

Address Line 2

City *

State *

Zip Code *

Primary Phone Number *

Alternate Phone Number

Email Address *

Secondary Member

Usually the enrolling minor. Can also be an adult who is not the responsible party for this agreement.

First Name

Last Name

D.O.B. +

Street Address

Address Line 2

City

State

Zip Code

Phone Number

Email Address

Additional Household Members

First Name

Last Name

D.O.B. +

Age

First Name

Last Name

D.O.B. +

Age

First Name

Last Name

D.O.B. +

Age

Emergency Contact Information

First Name *

Last Name *

Primary Phone Number *

Alternate Phone Number

Relationship to Enrolling Member(s) *

Payment Information

Select the membership that you are making a down payment on from the list below

Youth

	Standard ($299.95)
	Premium ($380.00)
	Unlimited ($450.00)

Adult

	Standard ($329.95)
	Premium ($460.00)
	Unlimited ($550.00)

Senior

	Standard ($307.50)
	Premium ($414.00)
	Unlimited ($495.00)

Little Tigers

($199.95)

Family (3 Children)

3 Members ($679.00)

4 Members ($759.00)

5 Members ($839.00)

Family (1 Adult + 2 Children)

3 Members ($724.00)

4 Members ($804.00)

5 Members ($884.00)

Family (2 Adults + 1 Child)

3 Members ($790.00)

4 Members ($870.00)

5 Members ($950.00)

I certify that I have read and agree to Martial Arts World & Fitness Center Membership Terms & Conditions *

Terms Accepted