O N L I N E   M E M B E R S H I P   R E G I S T R A T I O N
 
605 CULVER RD
ROCHESTER, NY 14609
585-654-7122
 

   
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 Enrollment Fee: $
 Prorated Dues: $
 Prorated Annual Rate Lock: $
 
 Total Initial Payment: $
 
 M E M B E R   I N F O R M A T I O N
   
 First Name   MI  
 Last Name
 Address 1
 Address 2
 City   St  
 Zip
 Country
   
   
   
Home Phone
Cell Phone
Work Phone
E-Mail
Confirm E-Mail
Company Name
Birthday
Referred By (Member #)
   
 M E M B E R   B I L L I N G   I N F O R M A T I O N
 Enrollment Billing Information  
   
 Credit Card Number
 Expiration Month
 Expiration Year
 Address
 Zip
   


 Monthly Recurring Billing Information  
   
 How would you like to pay for your monthly dues?
 I want to use my credit card.
 I want to use my bank account.
 B I L L I N G   F O R   M E M B E R S H I P
   
  Terms of Agreement:The initial term of this agreement is for 3 months. After the initial term of this Agreement, membership dues will automatically continue to be deducted from the pre-authorized account (see AUTHORIZATION FOR PRE-AUTHORIZED PAYMENT below) on a month-by-month basis unless terminated thirty (30) days in advance of the next billing date. Notice of cancellation must be given in person or via certified mail. After initial term, membership dues are subject to change at the discretion of Knockout Fitness.
  -  Your account below will be billed in the amount of $9.99 on or around the 18th day of the month until you cancel in accordance with this Agreement. This membership has a 3 months minimum term.
  -  An Annual Rate Lock Promise will be billed each year on or around the 4th of October, in the amount of $29.00, to the account on file. In order to cancel the billing of this fee, written notice and cancellation of your membership is required at least thirty (30) days in advance of the next billing date.
  -  If your membership has a 12-month term commitment, and you meet the criteria for cancelling your membership (see NOTICE OF CONSUMER RIGHTS), a $55 cancellation fee may be paid in order to cancel your membership.
  -  If any of your payments are returned or uncollectible for any reason, a $30 service fee for each returned or uncollectible payment will be assessed to the account on file and you will be charged a $5 late fee if payment is not made within ten (10) days after the day it is due.
   
 C O N T R A C T   T E R M S
 
 I have read the contract terms and accept them