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MEMBERSHIP CONTRACT
FITNESS U, L.L.C.
Initials ____ Page 1 of 2
Date: ___/___/______ Revised March 2010
GENERAL APPLICANT INFORMATION
Name: ________________________________________
Social Security Number: __________________________
Date of Birth: ___________________________________
Spouse's Name (If applicable): ________________________
Address: _______________________________________
City / State: _____________________________________
Zip: ____________________________________________________
Phone: ______________________________________________________
Email: ______________________________________________________
Employer: _________________________________________
Emergency Contact Name: ____________________________
Emergency Contact Phone Number: _____________________
Names on Contract: __________________________________
____________________________________________________________
1. MEMBERSHIP TYPE(S) AND DUES.
Group Quarterly
(3 months Paid in Full)
Annual with Monthly Payment
(Cash) (Automatic Withdrawal)
Annual
(Paid in Full)
General
Public
$39 ($117) $45 ($540) $37 ($444) $35 ($420)
Corp/Family
Discount
$37 ($111) $43 ($516)
$35 ($420) $33 ($396)
Start Date: ___/___/______ End Date: ___/___/______
Initial Dues: $________ (Monthly – pro-rated to next 15
th
day of a month)
Initiation Fee: $ 49 ($25 for reactivation within 90 days of cancellation; $0 for active renewals)
Total Due Today: $_______ (Initial Dues + Initiation Fee)
Payment Method:
[] Checking Account [] Credit Card: Visa/MC/American Express/Discover
Acct #: ___________________________________ Acct #: ____________________________________
Transit #: _________________________________ Expiration Date: ____________________________
Bank: ____________________________________
2. APPLICATION. I apply for membership in the Fitness U health and fitness club located in Strawberry Square at Third and Walnut Streets,
Harrisburg, Pennsylvania (the “Club”). I represent and warrant that I am 18 years of age or older and all facts and information set forth above
and/or in the Membership Application dated this date (the “Application”) are true, correct and complete. The Application is incorporated by
reference and made a part of this Contact.
3. PAYMENT.
a. Quarterly Payment: I must pay the Total Due Today upon signing this Contract.
b. Annual with Monthly Payment: Under this option, I must pay the Total Due Today upon signing this Contract. I agree to pay my monthly
amount ($________), or an increased amount as specified in Paragraph 7 for any renewal period, each month thereafter through “automatic”
withdrawal from an account I maintain in a financial institution pursuant to this signed authorization form or by cash or by check (if pre-
approved) delivered to the Club by the 15
th
of the month. Subject to change, drafts (payments) are made on or about the fifteenth (15
th
) of
each month. If I change financial institutions, I will provide Fitness U in writing all information needed for the replacement automatic
withdrawal at least ten (10) days before the effective date of the change. I agree to a membership term of one (1) year and acknowledge that
the automatic withdrawals (payments) will continue for that period unless I terminate my membership as permitted in this Contract or I
convert to another payment option with the consent of Fitness U pursuant to a new written contract.
c. Annual Payment: I must pay the Total Due Today upon signing this Contract.
4. TERM. All memberships, other than Quarterly memberships (with a term of three (3) months), have a term of twelve (12) months from the date
of the Start Date (or if none is specified, then the date of this Contract). Memberships may thereafter be renewed in writing at the then current
membership rate. By mutual agreement, one type of membership may be converted to another type of membership pursuant to a new contract with
Fitness U. The term of this Contract may be extended as follows:
a. If Fitness U temporarily closes for thirty (30) days or less, the term shall be extended for the number of days equal to the number of days that
the facility was closed (excluding holidays and any other days the facility is normally closed), at no additional cost to me.
b. I may extend the term of this Contract, at no additional cost to me, for the number of days equal to the days comprising the duration of my
disability, if my disability precludes me from using one-third (1/3) or more of the Club’s facilities for a period of less than six (6) months and
that disability is verified by a physician. To extend the term pursuant to this Paragraph 4b. I must give timely notice to Fitness U of my
request to so extend.
5. CANCELLATION. I (or my legal representative) may cancel this Contract without penalty in accordance with the following:
a. Until I receive a fully executed copy of this Contract. Upon such cancellation I will receive a full refund of all monies paid, including
initiation fees.
b. Within three (3) business days after signing this Contract and receiving a fully completed copy of this Contract. Upon such cancellation I will receive
a full refund of all monies paid, including initiation fees.
c. If I die or become permanently disabled. A permanent disability means a condition which precludes me from using one third (1/3) or more of the Club’s
facilities for six (6) months or more, and the condition is verified by a physician. Upon of cancellation under this Paragraph 5c., Fitness U shall refund to me
all monies paid in excess of an amount computed 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 an administrative fee of Fifty ($50) Dollars. Fitness U may require, at its
expense, a physician examination of me by a physician mutually agreed upon, to verify my disability, and I hereby consent to such examination.
d. If I move more than twenty-five (25) miles away from the Club. Upon cancellation under this Paragraph 5d., Fitness U shall refund monies using the same
computation described in Paragraph 5c. above.
e. If the Club closes for more than thirty (30) days and Fitness U fails to provide a comparable facility within ten (10) miles of the Club, I may cancel this contract
upon written notice to Fitness U. Upon cancellation under this Paragraph 5e., I shall be entitled to a refund of all monies paid in excess of an amount computed
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.
f. The buyer shall notify the health club of cancellation in writing, by certified mail, return receipt requested, or by personal delivery to the address
specified in the health club contract; 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 buyer has executed a credit, lien, or automatic funds transfer agreement with the health club to pay for health club
services, any negotiable instrument or credit or lien agreement executed by the buyer shall also be returned and any automatic transfer shall be canceled
within forty (40) days after the cancellation.
g. BUYERS RIGHT TO CANCEL: IF YOU WISH TO CANCEL THIS CONTRACT, YOU MAY CANCEL IT
BY DELIVERING OR MAILING BY CERTIFIED MAIL, RETURN RECEIPT REQUESTED, WRITTEN
NOTICE TO FITNESS U. THIS NOTICE MUST SAY THAT YOU DO NOT WISH TO BE BOUND BY THIS
CONTRACT. THE NOTICE MUST BE DELIVERED OR MAILED TO FITNESS U AT 201 STRAWBERRY
SQUARE, HARRISBURG, PENNSYLVANIA 17101. IN THE CASE OF TERMINATION UNDER PARAGRAPH
5b., THIS NOTICE MUST BE DELIVERED OR MAILED BEFORE 12:00 MIDNIGHT OF THE THIRD
BUSINESS DAY AFTER YOU SIGN AND RECEIVE A COPY OF THIS CONTRACT. IN SOME CASES, AS
DESCRIBED IN PARAGRAPHS 5a., c., d., and e. ABOVE YOU MAY ALSO CANCEL THIS CONTRACT