Ethos Gym Membership (yearly)

Terms:

$21.99 per week, with $50 Start Up fee

First Name:* First Name Required

Last Name:* Last Name Required

Address Line 1:* Address Line 1 is 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 (yearly) – Initial Payment	$65.45
Sub-Total	$65.45
10% GST	$6.54
Total	$71.99

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