GYM MEMBERSHIP INTAKE FORM
We look forward to welcoming you to PURE!

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Email *
Please indicate what type of gym membership you would like (price below does not include tax):
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Membership add-on:  24 hour key fob $75, one time fob purchase. *non refundable, non transferable*
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First and Last Name *
Phone Number *
Billing Address  (please include street, unit number, city, province/state, and postal code/zip) *
Credit Card Number
Expiration Date
CVV Security Code (3 digit code on back of card)
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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