New Membership Registration

Thank you for your new membership! Please answer the following questions:

Please provide the following contact information:

First Name

Last Name

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Work Phone

Home Phone

FAX

E-mail
Will any children be added to your membership plan?
Yes
No

If yes, how many?

Please select your membership plan:

Membership

Choose one of the following payment options:
Please enter the name on the credit card

Name
Please enter the credit card number, without any spaces or dashes.
Please enter the three-digit security code on the back of the credit card.
Please enter the expiration date of the credit card :
Please review our sales agreeement:
I am applying for membership into CLUB 4 LIFE and agree to be bound by the rules and regulations applicable to my membership as they are now written or may exist. It is understood that this agreement is for a minimum of twelve (12) months. Termination of this agreement by either the Club or me may take place after (12) months by giving a forty (40) day written notice to the Club Business Office or to my address in this application as the case may be, and paying all charges that are accrued or incurred. If written notice is not received, my membership will convert to a month-to-month basis. For my protection, my signature is required to process any cancellation request which includes completion of the Club’s Standard Resignation form. Until such notice is received by the Club’s Membership staff, my membership will remain active and I will be responsible for all membership dues for forty (40) days AFTER my notice is received. Usage or non-usage of the Club is not a factor in my dues responsibility. Membership may only be cancelled prior to twelve (12) months by one of the following explanations: 1. Written medical proof of injury, illness or disability. 2. Written evidence of relocation to a permanent residence more than twenty-five (25) additional miles from the home Club location if the Club is unable to transfer the contract to a comparable facility located within five (5) miles of new residence. Acceptable proof of relocation will include (but is not limited to) a lease, utility bill, home purchase contract, drivers license or letter of acceptance for a job transfer. All cancellations must include an exit interview with a membership representative. 3. I t is understood that the Club may suspend or terminate my membership for non-payment of dues or charges and/or violations of the Club’s bylaws, rules and regulations by myself or members of my family. I agree to abide by the laws of the Club as they may be promulgated from time to time. Monthly dues are subject to change at the discretion of the Club. If application for Senior Membership, I understand and agree to abide by all membership guidelines of this classification as outlined in our membership classification description________. Below is an explanation of the rights of any buyer of health club services pursuant to the Health Club Act, 73 Pennsylvania Statutes 2161-2177 THREE –DAY CANCELLATION. A member may cancel this contract without penalty within three business days of its signing and the date the member received a fully complete copy of the contract. Upon receipt of the notice of cancellation, the Club shall refund to the member all moneys, including any initiation fee, paid under the contract. TEMPORARY CLOSING. If the Club temporarily closes for thirty days or less, the member shall receive an extension of the membership term equal to the period during which the facility is closed. CLOSING OF MORE THAN 30 DAYS. A member may cancel the contract if the Club closes for more than thirty (30) days and the Club fails to provide a comparable facility within ten miles of the home Club locations. Upon receipt of such notice of cancellation under this paragraph, the club shall refund to the member all moneys paid in excess of an amount computed by dividing the full contract price, including the initiation fee by the number of weeks in the contract term and multiplying the rest by the number of weeks elapsed in the contract term. TEMPORARY DISABILITY. A member may extend the membership term of the contract at no additional cost for a period of time equal to the duration of a disability where the member has a disability which precludes the member from using one-third or more of the Club’s facilities for a period less than six months and the disability is verified by a physician. DEATH OR PERMANENT DISABILIY. The member or his or her legal representative may cancel the contract if the member dies or becomes permanently disabled. A permanent disability means a condition which precludes the member from using one-third or more of the facilities for six months or more and the condition is verified by a physician. Upon receipt of the notice of cancellation under this paragraph, the Club shall refund to the member all moneys paid in excess of an amount computed by dividing the full contract price, including the initiation fee, by the number of weeks in the contract term and multiplying the results by the number of weeks elapsed in the contract term, less a predetermined fee of $100, or if more than half the life of the contract has expired, a predetermined fee of $50. In the case of permanent disability, the Club may require the member to submit to a physical examination by a physician agreeable to the member of the Club. The additional cost of the examination shall be borne by the Club. RELOCATION. A member may cancel the contract if the member moves more than 25 additional miles from the home Club location and is unable to transfer the contract to the comparable facility located within five miles of his new residence. Upon receipt of notice of cancellation under this paragraph, the Club shall refund to the buyers all moneys paid in excess the amount computed as of the date of relocation by dividing the full contract price, including any initiation fee, by the number of weeks in the contract term and multiplying the result by the number of weeks elapsed in the contract term, less a predetermined fee of $100. HOW TO CANCEL. A member shall notify his or her home club cancellation in writing by giving forty (40) days notice, by certified mail, return receipt requested or by personal delivery. The address is Club 4 Life, One Racquet Lane, Monroeville, PA 15146. Notification of by electronic mail or facsimile shall not be acceptable. All money to be refunded upon cancellation of the health club contract shall be paid within forty (40) days of receipt of the notice of cancellation. If the member has executed a credit, lien, or automatic funds transfer agreement with the Club to pay for the health club services, any negotiable instrument or credit of lien agreement executed by the member shall also be returned and any automatic transfer shall be cancelled within forty (40) days after the cancellation. MEMBER RIGHT TO HAVE A COPY OF CONTRACT. Until this health club has provided the member with a signed copy of the contract written in full compliance with the Health Club Act, 73 P.5. 2161, et sep., a member may cancel the contract at any time. THIS HEALTH CLUB IS EXEMPT FROM FILING A BOND OR LETTER OF CREDIT WITH THE DIRECTOR OF THE BUREAU OF CONSUMER PROTECTION. Under this contract, no further payments shall be due to anyone, including any purchaser of any note association with or contained in this contract, in the event the Club at which the contract is entered into ceases operation and fails to offer a comparable alternate location within 10 miles. NOTICE OF MEMBER’S RIGHT TO CANCEL If you wish to cancel this contract, you may cancel by delivering or mailing by certified mail, return receipt requested, written notice to the Club. The notice must say that you do not wish to be bound by the contract and must be delivered or mailed before 12 midnight of the third business day after you sign and receive a copy of this contract. The notice must be delivered or mailed to Membership, Club 4 Life, One Racquet Lane, Monroeville, PA 15146. In some cases, you may also cancel this contract if you signed it before the club facility was completed, if the Club moves or goes out of business, if you become permanently disabled or if you move from the area. If you cancel, the Club may be entitled to a certain portion of the contract price. If the Club goes out of business or refuses to give you a refund, there may be a bond or letter or credit under which you are entitled to collect. For details, read your contract carefully. Enforcement of the Health Club Act is by the Attorney General of the Commonwealth of Pennsylvania or the district attorney of the county in which the health club is located. You may also bring in private cause of action. If your rights are violated, you may contact the State Bureau of Consumer Protection or your local district attorney. NOTICE TO ANY HOLDER OF THIS CONTRACT Any holder of this contract or note is subject to all claims and defenses which the debtor could assert against the seller of goods or services obtained pursuant hereto or with the proceeds hereof. Recovery hereunder by the debtor shall not exceed amounts paid by the debtor hereunder.
I ACCEPT the sales agreement
I DO NOT ACCEPT the sales agreement

First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Home Phone
FAX
E-mail

New Membership Registration

Copyright © 2005 Club 4 Life. All rights reserved. Revised: 11/27/05

Copyright © 2005 Club 4 Life. All rights reserved.
Revised: 11/27/05