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GYM MEMBERSHIP INTAKE FORM
We look forward to welcoming you to PURE!
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Email
*
Your email
Please indicate what type of gym membership you would like (price below does not include tax):
Single Month Gym $65
Three Month Gym $159
Six Month Gym $306
Twelve Month Gym $588
Month to Month, $55 (auto-renew 1st of each month)
Ten Drop-in Punch Pass ($110)
Clear selection
Membership add-on: 24 hour key fob $75, one time fob purchase. *non refundable, non transferable*
Yes, I would also like a 24 hour access key fob
No thank you, not right now.
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First and Last Name
*
Your answer
Phone Number
*
Your answer
Billing Address (please include street, unit number, city, province/state, and postal code/zip)
*
Your answer
Credit Card Number
Your answer
Expiration Date
Your answer
CVV Security Code (3 digit code on back of card)
Your answer
Authorization:
I understand that by submitting this form, I authorize PURE Gym & Juicery (1081310 BC LTd.) to charge my credit card with the above information.
How did you hear about us?
Any additional comments or concerns? Please let us know.
We thank you for supporting our business!
Click submit and we look forward to welcoming you to PURE very soon!
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