Membership Sign Up Form
Welcome to our Membership sign up form, please fill in all of your details on the form provided and we'll be in touch to complete your Membership request for you to officially join.
Sign in to Google to save your progress. Learn more
Full Name *
Email Address *
Full Address *
Telephone Number *
Membership Options *
Subject to time of the year on when you join, the price below will be on a pro-rota basis. Renewal of membership are at full price annually. 
Do you hold a Blue Light Card? *
If you happen to have a Blue Light Card which entitles you to various discounts (example of BLC below, additional details hidden due to privacy policy under GDPR), you'll be eligible for £20 admin fee waived on sign up. Please note you will have to provide a valid Blue Light Card upon request for you to claim this offer. Blue Light Cards are not an ID Card and you may be asked to provide additional ID.
Captionless Image
Promo Codes (if applicable)
I am ready to be accountable towards to my Health and Fitness but also my Membership journey with #BreakingRecords Fitness. By signing up as a Member for #BreakingRecords Fitness you accept and agree to the Terms and Conditions set on our website. If your unsure, please click here.
 *
I also understand that the 30 day time limit is in place to ensure I complete my Membership Sign Up to officially join and if I'm over the 30 day time limit, I accept my sign up form to complete my application to join as a Member will be mutually terminated and I may be charged £50 for wasting their time.
 *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of #BreakingRecords Fitness. Report Abuse
Google Forms