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Member Account #


5716 W. Hwy 290, #106
Austin, Texas 78735
Last Name First Name Middle Initial

Street Address City State Zip

Home Phone Work Phone Cell/mobile/pager

Email Emergency Contact Name Relationship Emergency Contact Phone

SSN# Birth date How did you hear about us?

o MONTHLY MEMBERSHIP : I understand and agree that my monthly membership dues of $________________, will be
automatically drafted from my credit card or bank account each month on the 10th or 25th (circle one) beginning ____/____/____
for a minimum of ______ months.

My automatic payment plan will automatically renew and continue until canceled by me in writing by certified mail. Cancellation
takes effect 30 days from postmark on certified letter. I agree to all membership terms and conditions as outlined below, on the back
page of this agreement, and the Automatic Payment Account Information page if applicable.

o PAID IN FULL MEMBERSHIP : Length of Time Purchased ______________ Expires _____/_____/_____

Initiation Fee: $_______________ Amt. Received Today: $_____________ * Cash * Check * CC

First Month’s Dues: $_______________ Balance Remaining: $_____________ * Payable by following installments

Registration Fee: $_____10.00______ AMOUNT DUE DATE PAYMENT METHOD

Equipment/Product (+ tax): $_______________ I NSTALL #1: $__________ ___/___/___ _______________ * APS DRAFT
I NSTALL #2: $__________ ___/___/___ _______________ * APS DRAFT
TOTAL AMOUNT DUE: $ I NSTALL #3: $__________ ___/___/___ _______________ * APS DRAFT
I NSTALL #4: $__________ ___/___/___ _______________ * APS DRAFT

Late Payment and Default: Should you default on any payment obligation as called for in this agreement, the entire remaining balance plus
any applicable fees shall be deemed due and payable upon demand.. You will be subject up to a $25.00 late fee (plus any applicable tax) for
any unpaid balances and returned checks, bank drafts, credit cards or debit cards due to (but not limited to) the following: NSF’s, closed
accounts, stopped payments, invalid accounts, declined credit card, lost or stolen credit card, holds on credit card, invalid or wrong credit card
expiration dates etc. It is your responsibility to notify AMERICAN PAYMENT SERVICES in writing of any change in your automatic draft
payment method 10 business days prior to your draft date. Any returned\declined credit card transactions will be drafted 10 days after the
initial transaction and will include late fees. We reserve the right to redraft any past dues amounts and\or service fees at any time without
prior notice to you. You grant AMERICAN PAYMENT SERVICES the right to use the account information from any payment method or
payments that you have given to redraft any past due amount and\or late fee.
By signing this contract you certify that you have read, understand and agree to all pages of this contract. 3). This contract is subject to
corporate office approval. No oral representation shall be binding on the health club or its owners.

______________________________________ ______/_____/ 20_____ ___________________________
Member’s Signature Today’s Date Employee’s Full Name (print)

YOU MAY CANCEL THIS CONTRACT AND RECEIVE A PARTIAL REFUND OF YOUR UNUSED MEMBERSHIP FEE BY MAILING A NOTICE TO THE FITNESS CENTER STATING YOUR DESIRE TO CANCEL THIS CONTRACT. Credit Card Processing. MARBLE FALLS. TX. but only pursuant to such rules. Monthly Dues: Monthly dues represent the cost of having use of the facility available to you for a thirty day period. contact Evolve Personal Training. Services: We agree to provide you with use of our facilities and all equipment and amenities which are available to you under the terms of your particular membership. would be detrimental to Evolve Personal Training or any of its Members. Rules and Regulations: By signing this contract. schedules and/or charges for such guest or guests as may then be in force by Evolve Personal Training. Memberships can be frozen for a $5. You will not have use of the fitness center if you have an outstanding balance. BOX 130. M ARBLE FALLS. We reserve the right to add or delete services. You are required to bring the slide card with you when you come to use the facility.O. Member agrees to maintain membership for the minimum length of time (term) as stated on this con- tract. TX 78654 IF YOUR DOCTOR DETERMINES THAT YOU ARE ILL OR INJURED TO THE EXTENT THAT IN YOUR DOCTOR’S OPINION YOU ARE UN- ABLE TO USE THE FACILITIES AFTER THE DATE THIS CONTRACT TAKES EFFECT. THE WRITTEN NOTICE MUST BE MAIL BY CERTIFIED RETURN RECEIPT MAIL TO THE FOLLOWING ADDRESS: P. Buyer’s Representations: You represent that you have not defaulted on any other contractual obligation with us. Guests: Member shall be entitled to bring a guest or guests to Evolve Personal Training. IF THE FITNESS CENTER GOES OUT OF BUSINESS AND DOES NOT PROVIDE FACILITIES WITHIN 10 MILES OF THE FACILITY IN WHICH YOU ARE ENROLLED OR IF THE FITNESS CENTER MOVES MORE THAN 10 MILES FROM THE FACILITY IN WHICH YOU ARE ENROLLED. YOU MAY NOT CANCEL AT THE FACILITY. satisfactory evidence of relocation such as a utility bill. If you are aware of any health problems. and we shall not be liable for any injury or damages resulting from your use of our services and facilities. regulations. & Collection PO BOX 130. Dues are considered fully earned the first day of any thirty day availability period.O. All prices are guaranteed for only the length of time stated in this agreement. No guest may use the fa- cilities without “signing in” at the front desk and no guest may use Evolve Personal Training or any of its facilities or activities without being accompanied at all times by the member. Relocation: You may cancel a term contract if you relocate more than twenty-five (25) driving miles from the facility at which you enrolled or from an affiliated facility. THE FITNESS CENTER MAY REQUIRE PROOF OF ILLNESS OR INJURY. fees. WE DO NOT GIVE REFUNDS. Member will be responsible for all unpaid balances as well as court costs and legal fees associated with recovering said balances. Evolve Personal Training reserves the right to limit the number of guests or the number of times any one guest can use Evolve Personal Training facilities and reserves the all rights to exclude any guest whose use of the fa- cilities. TX. AMERICAN PAYMENT S ERVICES Automatic Customer Payments. assign or transfer our right to receive payment from you at our discretion.00. you are purchasing the privilege of membership to the facility. Bank Drafts. O. TX 78654 TOLL FREE PHONE: 888-493-9777 FAX: 830-798-8610 . Assignment of Contract: We reserve full authority to sell. amenities. BOX 130. regardless of circumstance. Initiation Fee: By paying the initiation fee. MARBLE FALLS. EVOLVE PERSONAL TRAINING TERMS & CONDITIONS Membership Information: If you have any questions regarding your membership. we urge you to see your doctor before using our facilities. You will be mailed (to the address you provided on the front) a membership letter containing a copy of this contract along with a membership slide card. Drafting memberships automatically renew and can be cancelled only after the minimum contractual term has passed by following the cancellation policy in the following paragraph. and no oral promises are part of the agreement. CANCELLATION POLICY: Please note all draft memberships will continue on a month to month basis until cancelled by member with a 30 day written notice.00 cancellation fee and you must not carry a past due balance. disability & death exceptions).O.00 fee. Cancellation prior to the agreed upon term does not eliminate member’s obligation to continue making monthly payments as stated in this agreement (see health. YOU MAY CANCEL THIS CONTRACT BY MAILING A NOTICE TO THE FITNESS CENTER STATING YOUR DESIRE TO CANCEL THIS CON- TRACT. If for any reason a member is unable to use their membership. Funds must be available on the date of payment and after until such payment clears. You must give a written notice of your intention to cancel. BOX 130. Your membership slide card must be returned with your cancellation. you are not relieved of your payment obligation. and you agree to follow them.00 a month fee. ACCOMPANIED BY PROOF OF PAYMENT ON THE CONTRACT. Term memberships paid on a monthly basis may freeze time not pay- ments. a $25. TX 78654. This must be sent in by certified return receipt mail to the following address: AMERICAN PAYMENT SERVICES . All cancels take effect 30 days from the postmark on the certified letter. P. Freezes: You have the option to freeze your membership up to 6 months at a time. M ARBLE FALLS. BOX 130. 78654. MARBLE FALLS. Replacement cards are $10. The initiation fee is considered fully earned upon commencement of your membership and as a result is non-refundable. YOU MAY NOT CANCEL AT THE FACILITY. the member may transfer the remaining time to another person for a $25. If you have. Waiver and Release: Use of our facilities is at your own risk. you acknowledge the rules and regulations governing the conduct of members and guests. in the sole opinion of Evolve Personal Training. Restriction on Cancellation: If you fail to use your membership and do not use our facilities. Complete Agreement and Severability: The terms on both sides of this contract constitute the full agreement between you and us. Member must send a written notice by certified (returned receipt) mail to the following address: AMERICAN PAYMENT SERVICES . and hours as reasonably warranted. P. we may apply all amount paid on this contract to your past unpaid obligation before processing this contract. 78654. THE WRITTEN NOTICE MUST BE MAILED BY CERTIFIED MAIL TO THE FOLLOWING ADDRESS: P. except as provided for in this contract.

Credit Card Processing. EVOLVE PERSONAL TRAINING AUTOMATIC PAYMENT ACCOUNT INFORMATION I understand and agree to use the account information below for my membership dues as outlined on page 1 and 2 of my membership agreement with Evolve Personal Training. (***All numbers including expiration date must be legible***) This page is an addendum to your original membership contract with Evolve Personal Training. & Collection PO BOX 130. M ARBLE FALLS. TX 78654 TOLL FREE PHONE: 888-493-9777 FAX: 830-798-8610 . Address Phone # DL # _________________________________________________________ $ ___________________________________________________________________ Your Bank Name ____________________________ Bank Routing & Account # (***Do not use a deposit slip or a credit union savings account*** ⇒ CREDIT CARD DRAFT (Attach voided credit card slip here): XXXX XXXX XXXX XXXX Mo/Yr thru Mo/Yr DATE SERVER/CASHIER Payee’s Name AUTHORIZATION NO REFERENCE NO Evolve Personal Training Imprinted XXXXXXXXX QTY. AMERICAN PAYMENT S ERVICES Automatic Customer Payments. Bank Drafts. DESCRIPTION AMOUNT TAX P URCHASER SIGN HERE SALES X Cardholder acknowledges receipt of goods and/or services in the amount SLIP of the Total shown hereon and agrees to perform the obligations set forth TOTAL in the Cardholder’s agreement with the issuer. Membership Contract #: _______ Print Members Name : _______ Member’s Signature: Date / / **Signature of Authorized Account Holder (if not member:) Please print Authorized Account Holder’s name: ⇒ BANK DRAFT (Attach voided check here): Payee’s Name Ck No.

employees. Which days of the week will you most often work out? Sleep problems Recent surgery Mon Tue Wed Thur Fri Sat Fatigue/Drowsiness Asthma Staff should know: Nervous Tension Headaches Physical activity Lightheadedness/Fainting Major Coronary Risk Factors: (check any that apply) Diagnosed with hypertension High cholesterol (>200mg/DL) Diabetes Mellitus Family history of coronary disease Type I Cigarette smoker Phlebitis Embolic Diabetes Mellitus Other heart conditions: Type II High Blood Pressure Do you take a Beta Blocker? Yes No Are you taking medication/supplements to help with weight loss? Yes No Read and sign acknowledgement and agreement to the following: The above screening has been reviewed prior to engaging in any physical activities. defend and hold harmless Evolve Personal Trainingand its officers. attorney fees and expense incurred either directly or indirectly by reason of. resulting from. . I do hereby waive. in the addition of any payment of any fees or charges. you should discuss this exercise program with your physician. its officers. Texas 78735 512. agents. employees. OR that I have decided to participate in activities. I also hereby release all of the above and any others acting in their behalf from any responsibility or liability for any injury of damage to myself or my belongings. I do hereby further declare myself to be physically sound and suffering from no condition. Medical Information (check any that apply) 1. I am voluntarily participating in these activities and using Evolve Personal Training facilities and equipment with full knowledge of the dangers involved. executors. representatives or assigns hereby agree to indemnify. 5716 W. use equipment and weight loss without the approval of a Physician and do hereby assume all responsibilities. including those caused by negligent act or omission. In consideration of being allowed to participate in the activities and programs of Evolve Personal Training and use of its facilities and equipment. or following a diet to treat an illness or disease. representatives. You are advised to consult with your physician prior to beginning this exercise program and encouraged to seek periodic medical check-ups. including any interest. MEMBER: Printed Name Signature Date PARENT OR GUARDIAN IF MEMBER IS UNDER AGE 18: Printed Name Signature Date EVOLVE PERSONAL TRAINING REP Printed Name Signature Date . the member or participant understand and agree that fitness activities including weight loss may be strenuous and/or hazardous activities and I should contact a healthcare professional or doctor before beginning any new activities or weight loss program. Problem knees 3. I acknowledge that I have either had a physical examination and have been given my Physician’s permission to participate. taking prescription medication. or use of equipment. release and forever discharge Evolve Personal Training . #106 Austin. I hereby agree to expressly assume and accept any and all risks of injury or death related hereto. or associated with this Agreement and/or Evolve Personal Training . or other illness that would prevent my participation or use of the facilities and equipment.358. penalties. agents. What time will you most often work out? Morning Afternoon Evening Sports injury . Hwy 290. and all others from all responsibilities or liabilities for any injuries or damage resulting from my membership or participation in any activities. successors or assigns from any and all claims for liability against without limitation.8433 PERSONAL TRAINING STUDIO SCREENING AND RELEAS ES Evolve Personal Training is not a medical organization and its staff cannot provide medical advice. What are your goals? (check all that apply) Overweight Pregnant Lose inches Better fexibility Shape and tone Be healthier Poor posture Hypoglycemia Better posture More energy Arthritis/Bursitis Drug allergies Other (specify) Bad back Hernia 2. If you are under the care of a physician. in connection with participation/membership or use of equipment at Evolve Personal Training INDEMNIFICATION: Member and all heirs. I. I do further hereby acknowledge that I have been informed of the need for a Physicians approval for my participation in exercise/fitness/weight loss activities. impairment. contractors.