Member Info

Member 1 (Leader of the Group)

Basic Info

Billing Address

Card Info


/

Emergency Contact


Member 2 (Friend)

Basic Info

Billing Address

Card Info


/

Emergency Contact


Member 3 (Friend)

Basic Info

Billing Address

Card Info


/

Emergency Contact


Member 4 (Friend)

Basic Info

Billing Address

Card Info


/

Emergency Contact


Member 5 (Friend)

Basic Info

Billing Address

Card Info


/

Emergency Contact

Additional Notes

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By submitting this form, I/we understand monthly billing will take place in conjunction with the membership I/we have purchased.