ANNUAL MEMBERSHIP AGREEMENT Between Namibia Fitcity Health & Wellness center (cc/2018/01399) and the "Member" Personal details of the Member Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastDate of BirthAddressMobile number *Id numberEmail *Do you declare a disability *yesNoPlease specify your disabilityPhysical activity readiness questionnaire All information is held in strictest confidence and accessible only by the gym manager and relevant staff.Have you, for any reason, been unable to exercise in the past?yesNoHas your physician ever advised you against exercising?yesNoHave you suffered from respiratory difficulties?yesNoHave you ever suffered from fainting, migraines or loss of balance?yesNoHave you ever suffered from any bone, joint or muscle related diseases?yesNoIs there any history of heart disease in your family?yesNoHave you experienced chest pain whilst exercising?yesNoDo you have high blood pressure?yesNoDo you have elevated cholesterol levels?yesNoAre you currently taking prescribed medication?yesNoPayment instruction/Debit mandate *This is my/our instruction to my bank to make payment as stated below and my/our bank can debit my/our bank account.Name and surname of card holder *FirstLastAddress *Account Holder's Bank *Branch Name and Branch Code/ BIC Code *Account number *Type Of Account *CurrentSavingsTransmissionAmount of deduction authorized by Account Holder *Date of first deduction *Terms and Conditions *I agree to the terms and conditions of this Fitcity membershipSubmit Download Your Membership Contract Regular Application Download Regular 1-month Download 3-month Contract Download 6-Month Contract Download Student & Athlete Download Student Unlimited Download
