Enrollment for Active Participant Club Status

* indicates a required field

Before you begin online enrollment please be sure you have your ACH bank information and your W-9 information on hand.

Facility Name

Full legal entity name (ex: Gym, Inc., or Gym, LLC)

Facility Description

Facility Website * If you do not have a website, or you use Facebook as your website, please leave this field blank.

How does/will your club collect usage for members?

If "Other" please describe

Location Information

Club County

Physical Address

Physical Address 2

Physical City

Physical State/Territory

Physical Zip Code

Mailing Address

Mailing Address 2

Mailing City

Mailing State/Territory

Mailing Zip Code

ContactNumber

I have multiple locations

All legal terms, conditions, fees, and responsibilities will apply to each location as outlined in the HC and any affiliate legal agreements connected to the chosen program

Contact Information

Primary First Name

Additional Name

Primary Last Name

Primary Position

Additional Position

Primary Contact Number

Additional Contact Number

Primary Contact Number 2

Additional Contact Number 2

Primary Fax

Primary Email

Additional Email

Enrollment for Active Participant Club Status

Tell us about your Facility

Location Information

Physical Address

Mailing/Legal Entity Address

Contact Information

Contract Signee

Primary Contact (if different from signee)