WINNIPEG MUAY THAI & KICKBOXING MEMBERSHIP FORM

New Member (Fill sections 1, 2 & 3)

Renewing Member (Fill sections 1 & 3)

1. Membership Details

Membership Start Date

Title

First name

Last name

Membership Term

3 Months - $240.00 - Full Payment due upon signup

$85.00 monthly Due at the beginning of each month

2. Member Details

D.O.B

Address

City

Province

Postal Code

Telephone (H)

Do you consent to receive information about Winnipeg Muay Thai & Kick Boxing via email?

Yes

Emergency Contact

Name

Phone

3. Member's Declaration and Payment Details

Before signing this document, I have read, understand, and hereby agree to the terms and conditions of membership as defined within this membership form and know that it may affect my legal rights. Fees paid are for your membership whether you attend or not.

Package Fee (If selected - for new members only)

Signature

By typing my name above and checking this box, I acknowledge and agree to the terms and conditions of this membership. I understand that this constitutes my legally binding electronic signature.