First Name:

Last Name:

Address:

Address 2:

City, State & Zip Code:

Country:

Date of Birth:

Email Address:

User Name (6 - 8 characters):

Password (6 - 8 characters):

Membership Type - Please choose one:                $29.95 - 30 Day Membership

                                                                                     $64.95 - 90 Day Membership

                                                                                     $99.99 - 180 Day Membership

Signature:______________________________                     Date:____________________
Please note that by completing and signing this form you are verifying that you are 18 Years or older
and have read and agree to all terms and conditions located on our legal terms and conditions page.

* Please note: I will email you your user name and password the same day I receive payment if you choose to pay with cash or money order. However, if you choose to pay by check, I will email your user name and password after your check has cleared my bank (usually 5-10 business days).

Please make check or money order payable to: Fitness Endeavors LLC.
Print, sign and mail this form with payment to:

                                Fitness Endeavors LLC.
                                         P.O. Box 497
                              South Windsor, CT. 06074