MAKING THE WORLD A FITTER PLACE

CORPORATE MEMBERSHIP APPLICATION FORM
COMPANY / THE BAR COUNCIL MEMBERS / Company Registration #
ALL THE EMPTY FIELDS BELOW ARE MANDATORY. PLEASE COMPLETE IN BLOCK CAPITALS.
Important Note: if you are an existing member of Fitness First, you may be transferred on to your company’s corporate plan. However, the cut-off date for changes is 15th of the month to be processed for the 1st of next month
ARE YOU AN EXISTING FITNESS FIRST MEMBER? / If yes, enter your existing club name and membership number here:
PERSONAL DETAILS
We will use the information below to help us manage your membership
Title (Circle One) / MR / MS / MRS / MISS / OTHER: / Gender (Circle One) / MALE / FEMALE
First Name / Last Name / Date of Birth / DD / MM / YY
Work Email Address
If you don’t want to receive great offers from self employed Personal Trainers or our First Club partners
(including free registration for First Club member benefits via your email address), tick here
Home Address 1
Home Address 2
HomeTown / City / County
Postcode / Mobile Telephone
Home Telephone / Work Telephone
MEMBERSHIP DETAILS
Club Access / BLACK £45.95 / PLATINUM £35.95 / BLUE £25.95 / MULTICLUB
Home Club / Membership Start Date / DD / MM / YY
Membership Term / 12 MONTHS FROM AND INCLUDING MEMBERSHIP START DATE
I hereby apply for corporate membership of Fitness First Health Clubs Limited. I agree to abide by the Fitness First Corporate Membership Terms & Conditions, as detailed overleaf, or as varied thereafter. I hereby state I am a current employee of the Company and confirm my eligibility for this membership benefit:
Member Signature / X / Date / DD / MM / YY
PAYMENT DETAILS
1) Start up fees payable by member (If yes, complete 3)) / NO / Amount inc. VAT if yes / £0.00
2) Dues payable by Corporate Member (If yes, complete 4)) / YES / Amount inc. VAT if yes
3) Credit/Debit card details Card type: Master card/Switch/Visa/Visa delta / Your alternative method of payment should relate to a bank account which differs from that which you nominate for your monthly direct debit.
Name as Issue number appears on card
Card Number
Valid from / DD / MM / YY / Expiry date / DD / MM / YY / Credit card holder’s signature / X / Date / DD / MM / YY
4) Instruction to your Bank or Building Society to pay by Direct Debit
Name and full postal address of your Bank or Building Society
To: The manager ...... Bank/Building Society
Address ......
......
...... Post code ......
Name(s) of account holder(s) ......
Branch sort code Bank/Building Society account number
- / -
Banks and Building Societies may not accept Direct Debit instructions from some types of accounts. See the Direct Debit indemnity under the terms and conditions overleaf. / Service User Number
7 / 5 / 6 / 7 / 8 / 3
Billing Reference Number
(BRN)
Instruction to your Bank or Building Society
Please pay Fitness First Clubs Ltd., Direct Debits from the account detailed in this instruction subject to the safeguards assured by the Direct Debit guarantee.
I understand that this instruction may remain with Fitness First Clubs Ltd., and if so, details will be passed electronically to my Bank/Building Society.
Signature(s)
X
Date
D / D / M / M / Y / Y