Name *

First Name

Last Name

Phone *

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###

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

By selecting the boxes below you are acknowledging you agree to the contract terms set forth *

I understand & agree to pay the set program fee due monthly.

I understand & agree to notify Mindy at least 48 hrs. in advance of the scheduled workout. If Mindy has not been notified before the designated time, you will be billed for your absence.

I understand & agree program start date and times have been established.

I have read and understand the above contract terms.

Date Agreement Signed *

MM

DD

YYYY