Entry Application Form REFERENCE CODE Date of Registration

APPLICANT INFORMATION
Name : Surname :

Phone Date :

ID/Passport No.

Membership ONYX SUBSCRIPTION R 350.00 x Monthly Sub: R 250 JASPER SUBCRIPTION 1 050.00 x

Water L: P: PACKAGE PLAN WATER L: P: PACKAGE PLAN

My Orders
Therapy AQ-AIRLIFE: 20M 30M 3 in 1 W: AIR-PW: Therapy AQAIR 20M 30M

Entrée forms is important please note to fill in this short and briefing application form, use only valid details. Thank you
Disclaim
Acceptance of terms
Thank you for choosing aQua Lifestyle Club (ALC). The following Terms and Conditions and the Privacy Policy (together, the “Terms”) apply to any person that registers an Account "membership" through the membership Application form. The
Terms constitute a legally binding agreement between you and aQua lifestyle Club trading, which is a company incorporated under the laws of South Africa.
By registering aQua Account "membership, you unconditionally accept these Terms and agree to be bound by and act in accordance with these terms. You also accept and agree that you are solely responsible for understanding and complying
with all laws, rules, regulations and requirements of the jurisdiction in which you live that may be applicable to your use of the aQua application and/or your aQua Account. Please read these Terms carefully before filling the application form.
Thank you
Terms and Condition
I certify that my answers are true and complete to the best of my knowledge. If this application leads to aQua Lifestyle Club (“ALC”) business admin, I understand that false or misleading information in my application may result in my release of
membership. To be a member of ALC as per your selected choice in an application a business membership is once-off registration fee of R350 business membership and Nonrefundable with Jasper membership is R1 050 annual will accept terms
and comply as per choice.
Identity verification – aQua implements and maintains the highest standards of Know Your Customer (“KYC”) processes and controls as part of our commitment. To ensure we meet these standards, our customers are required to provide certain
personal details and documents when registering membership (“Identity Verification”). I, therefore, certify that all the information I have provided is correct, and have attached all the necessary documentation required by (“ALC”), I certify that
aQua Admin can use all the information to contact me and is correct.
Eligibility – By registering aQua Account "membership", you expressly warrant and represent that: You are 18 years of age or above and have full capacity to accept the Terms and enter any transaction available through the application. You will
not open, or attempt to open/or register, an aQua Account/or membership under any name except your own; or use your aQua application to carry out transactions on behalf of a third party; You will follow the aQua Business account application
process if you seek to open and use an aQua Account for a non-individual legal entity (e.g. a company, trust or partnership); You will not have more than one aQua Account/or membership; use or access any aQua Account other than your own; or
assist any other person in obtaining unauthorized access to any aQua Account *membership;

New member Name: Member Signature: Admin Signature:

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