Name First Last Bronze Gold Platinum Elite Royal 12 Months $65 12 Months $85 12 Months $120 12 Months $140 12 Months $320 12 Months $75 12 Months $95 12 Months $140 12 Months $160 12 Months $420 12 months Royal $320 12 months Elite $140 12 months Platinum $120 12 months Gold $85 12 months Bronze $65 6 months Royal $420 6 months Elite $160 6 months Platinum $140 6 months Gold $95 6 months Bronze $75 I,_____________________________ authorize Ideal Body Clinic to deduct membership fee of $_______tx the first of every month for the period of ____________________ from the credit card information provided below, or a series of post dated checks that are provided, or the full amount of $________tx that has been prepaid. full name full namefee chosenfee chosenPlease note that treatments not used in the present month are not able to be transferred to the following month. There is no refund or exchange on the amount which has been paid. This member contract is non-transferable. Also, 30% penalty charged on the total amount of the contract in case of cancelation. Before signing this document. I have read, understood and herby agreed to the terms and conditions of membership. Credit Card InformationMasterCardVisaCredit Card Number Expiration Date Membership Start Day MM slash DD slash YYYY Membership End Day MM slash DD slash YYYY Today's Date MM slash DD slash YYYY Signature Like Us On Facebook Appointments We will do our best to accommodate your busy schedule. Request an appointment today! Request Appointment Contact Us (514) 998-0998 Ideal Body Clinic Montreal Ideal Body Clinic South Shore Ideal Body Clinic Montreal East Call Us Text Us
