Ethos Gym Membership (weekly)

Terms:

$25 per week, with $50 Start Up fee

First Name:* First Name Required

Last Name:* Last Name Required

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City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Mobile:* Mobile is Required

DOB:* DOB is Required

Gender:* Gender is Required

Female Male N/A

I agree to the Terms & Conditions linked above*

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Description	Amount
Ethos Gym Membership (weekly) – Initial Payment	$68.18
Sub-Total	$68.18
10% GST	$6.82
Total	$75.00

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