Health Club

   
SECURE REGISTRATION FORM

Annual Membership in our health club entitles
each member to special product pricing and other
rewards as they become available.

The annual membership fee of $15.00 can
usually be recovered with one order.

Join Today!

Membership Application

Please complete the following form. 

     Your Name:
Street Address:
          City:
         State: Zip:
         Phone:-
           Fax:-

 Email Address: 
                         (Required)  

Social Security # 
                        (Required)  


Your Social Security Number will be used
as your Health Club Member Number.

This number is required to obtain the
Health-Club discounts on all products 
and will not be given to any outside
individuals or organizations.



CREDIT CARD INFORMATION 

        Amount:

      Type of Card:
      Visa    Mastercard

      Name on Card:
      
      Card Number: 
      
      Exp. Date:

Comments or Questions

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