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Chattanooga MMA College Membership Application and Agreement

I/We desire to become members of Chattanooga Mixed Martial Arts College and hereby provide the following information of our application:
Member(s) Information:
1. Name ________________________________________ ______ _____________ Soc.Sec # ________________ Scan Code: _______________ Last First MI Date of Birth
2. Name ________________________________________ ______ _____________ Soc.Sec # ________________ Scan Code: _______________ Last First MI Date of Birth
Address: ____________________________________________________________________ Phone: ______________________________________ Number & Street City State Zip
Mobile Phone: ______________________ Email Address: ________________________ If you do not have an email address, please initial: ______
Occupation: ___________________________ Employer: _________________________________ Work Phone: ____________________________
Business Address: ________________________________________________________________ Number & Street City State Zip
Occupation: ___________________________ Employer: _________________________________ Work Phone: ____________________________
Business Address: ________________________________________________________________ Number & Street City State Zip
Family Members
3. Name ______________________________ Age ________ Birth date _____________ Scan Code: __________________ 4. Name ______________________________ Age ________ Birth date _____________ Scan Code: __________________
EMERGENCY CONTACT:
Name: ________________________________________ Relationship: _______________________________ Daytime Phone: ____________________________ Evening Phone: ________________________________
Membership Type: ________
________
________
________
Fees and Dues:
Enrollment Fee:
fee is non-refundable.
Monthly Dues for the membership selected are $________ per month. Monthly dues for the following month, along with authorized member charges will be collected electronically after the 5th of the month, unless previously paid by other means. All members must provide Electronic Funds Transfer information required below. In the event we are unable to collect payment electronically, the member will be notified and payment must be made by other means, no later than the 20th day of the month in order to maintain membership privileges.
• I understand that all Enrollment Fees and Membership dues are subject to applicable state sales tax.
• I understand that all agreements are 12-month and will automatically renew on a month-to-month basis until cancelled by the member.
• I understand that my account will be charged and billed with the monthly billing for any programs and services not paid at time of registration.
• Chattanooga MMA College dues must be current at all times or fitness membership will be suspended or terminated.
Individual Add On Add On Add On
$___________________ Member Name: __________________________________ $___________________ Member Name: __________________________________ $___________________ Member Name: __________________________________ $___________________ Member Name: __________________________________
To establish and qualify for membership, member agrees to pay a one time enrollment fee of $______________. Enrollment
Payment Summary:
_____ 12 Month Billing _____ Month-to-month Billing _____ 3 Month (student)
Total Enrollment Fee with tax: Prorated month’s Dues with tax: Paid in full with tax:
Total Payment upon Enrollment:
$___________
$___________
$___________
$___________
Next Billing Date: _______________________
Payment Authorization Agreement:
Membership Number: __________________
Bank Name: ______________________________ * Must provide voided check
Account Number: ________________________
Routing Number: ________________________
Payment method: _____ Cash _____Check # ________ _____ Bank Card #: _____________________________ Card #: __________________________ Exp. Date _______
Acceptance and Agreement
I/We hereby agree to accept and abide by the terms of this Membership Application and Agreement. I/We understand that this membership agreement is for a term of twelve (12) months and will continue thereafter on a month-to-month basis unless cancelled by me (either of us). __________ Initials
I/We (Member) hereby authorize Chattanooga MMA College to effect payment for monthly dues and approved membership charges for the duration of
my/our membership through electronic funds transfer. This authorization is to remain in full effect until Club has received WRITTEN NOTIFICATION from me (either of us) on cancellation in writing by fax, by certified letter, return receipt requested THIRTY DAYS NOTICE. ______ Initials
__________________________________________ _______________________________________________ Member Date
_________________________________________________ Accepted by Date

1. PROVISIONS. The Chattanooga MMA College will provide a fully equipped exercise facility including a fitness training area with stationary bicycles, elliptical, treadmills, circuit training equipment and free weight training area. The Chattanooga MMA College and facilities may be unavailable during a period of repair and maintenance or special events, programs or private parties, or by Management’s schedule for these events. In order to keep the facility in the best possible condition a portion of the Chattanooga MMA College may be closed for a temporary time period for repairs and renovations. There will be no adjustment in dues for this period of closure.
2. MEMBER’S HEALTH WARRANTY. The member warrants and represents that the member or any family member or guest entitled to use the facilities of the Chattanooga MMA College under the terms of membership, has no disability, impairment, or ailment preventing him/her from engaging in active or passive exercise, or that will be detrimental or adverse to such person’s health, safety, or physical condition if he/she does so engage or participate. The Member acknowledges and agrees that: 1) the Chattanooga MMA College will rely on the foregoing warranty in issuing the Membership; 2) the Chattanooga MMA College shall have no obligation to perform a fitness assessment or similar testing to determine the Member’s physical condition; 3) if any fitness assessment or similar testing is performed by the Chattanooga MMA College it is solely for the purpose of providing comparative data with which the Member can track progress in a program and is not for diagnostic purposes. 4) The Chattanooga MMA College shall not be subject to any claim, demand, or injury whatsoever on account of the HVL Fitness Club’s evaluation or interpretation of such fitness assessment or similar testing. 5) TheChattanooga MMA College shall not be liable for any injury arising out of the member’s disability impairment or ailment preventing him/her from engaging in active or passive exercise, or that would be detrimental or adverse to such person’s health, safety or physical condition if he/she does so engage or participate. Each member and guest should be aware of his/her medical history and should consult with a physician prior to engaging in exercise or continuing to exercise if a medical condition appears or appears to be developing.
3. LIABILITY AND WAIVER OF LIABILITY. Each member of the Chattanooga MMA College shall be liable for any property damage and/or personal injury (caused by the Member, Member’s Family, Guest or any other person) at the Chattanooga MMA College or any activity or function operated, arranged or sponsored by the Chattanooga MMA College. It shall be the obligation of the member to pay for any costs involved upon presentation of a statement thereof. Any and all use of the Chattanooga MMA College Facilities, or participation in, the Chattanooga MMA College, activities operated, arranged or sponsored by the Chattanooga MMA College either on or off of the Chattanooga MMA College’s premises by the Member, Member’s Family or Guest(s) shall be AT SUCH PERSON’S OWN RISK, and the Chattanooga MMA College shall not be liable for any injuries or damages to such person, or the property of such person, or be subject to any claim, demand, injury or damages. The Member individually, and on behalf of the Member’s personal representative, heirs, administrators, assigns and successors does here by expressly forever release and discharge the Chattanooga MMA College, its successors and assigns, as well as its officers, agents and employees from all such claims, demands, actions, or causes of action.
4. SUSPENSION/TERMINATION OF MEMBERSHIP BY MANAGEMENT. Management has the right to suspend and/or terminate any membership for non-payment of dues, fees, Chattanooga MMA College dues, or for behavior inimical to the enjoyment of the HVL Fitness Club by other members and staff for any reason deemed sufficient in the sole discretion of Management.
5. BUYER’S RIGHT TO CANCEL OR TERMINATE. Members have the right to cancel this contract within three (3) business days after receipt of a copy of this contract. Cancellation must be in writing and delivered to Chattanooga MMA College either in person, by fax or by certified registered mail. All faxed and mailed cancellations will be dated 30 days from fax date or postmark. Dues for the final month will be pro-rated and billed during the final month. In the event of a three (3) day cancellation, the Chattanooga MMA College will refund all enrollment fees and dues paid. Month-to-month members may voluntarily terminate membership at any time after their 12 month agreement for any reason by: 1) notifying the Chattanooga MMA College in writing by fax, certified mail, return receipt requested or in person 30 days prior to cancellation and; 2) paying all current charges prior to termination. Chattanooga MMA College Enrollment Fees are non-refundable except as indicated above.
6. UNPAID BALANCES. All balances which are 30 days past due are subject to a $25.00 monthly service fee. In addition to other rights, Management reserves the right to:
1. Collect the current and past due balance.
2. Suspend and/or terminate membership privileges.
3. Recover from Member(s) any collection fees, court costs, and reasonable attorney’s fees agreed to be 30% of the entire balance due and owing.
4. Collect a service fee of $30.00 for any check or draft payable to the Chattanooga MMA College which is not honored.
7. AGREEMENT AND RELEASE OF LIABILITY. Chattanooga MMA Colleger will provide access to the building using a barcode system. I acknowledge the supervision is not always provided at the facility. I acknowledge that use of the barcode system by someone other than myself will result in loss of membership. ___________ Initials
8. ENTIRE AGREEMENT. This agreement and Bylaws constitute the entire and exclusive membership agreement between the parties. Any promise, representation, understanding, oral or written, pertaining directly or indirectly to the agreement which are not continued herein, are hereby waived.
9. I certify that I have received a copy of the Rules and Bylaws and have read and understand them.
__________________________________ _______________

Signature of Member                                      Date

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Witness