Register Page - Project Better West

First name

Last name

Email address

Mobile phone

Date of birth

Address

Gender

Upload a profile photo

Member ID

Password

Confirm Password

Location

Membership type

Fitness Passport
Fitness Passport Members

Are you aged over 60 years of age:

Yes

No

Do you have any joint or muscular problems that may affect your ability to train:

No

Yes Please explain:

Do you have any other conditions or injuries that may affect your ability to train:

No

Yes Please explain:

I have watched the induction video and understand how to safely use the facility

Terms and Conditions

Debit Authority Form

Welcome to Project Better!

You’ve taken the first step to a healthier you!

You have signed up for:

Membership Type: *****

Start Date: *****

Contract Length: *****

Payment amount: *****

Debit Day: *****

Home Club: *****

You have successfully applied for gym access
Your application will be reviewed and granted access on approval

Name

Molly Smith

Email Address

mollysmith@gmail.com

Mobile Phone

+61 419 475 184

Date of Birth

12/01/1991

Gender

Female

Address

23 O'Neil Lane, Collingwood, VIC, 3066

Password

**************

Emergency Contact

Anna Smith

Emergency Contact Phone

+61 485 294 294

Emergency Contact Relationship

Mother

Payment Method

Credit Card

Payment Frequency

Monthly

First Payment Date

12 OCtober, 2022

Member Details

Terms and Conditions

Debit Authority Form

Welcome to Project Better!

You’ve taken the first step to a healthier you!

You have signed up for:

Name

Email Address

Mobile Phone

Date of Birth

Gender

Address

Password

Emergency Contact

Emergency Contact Phone

Emergency Contact Relationship

Payment Method

Payment Frequency

First Payment Date