Gym Membership

Gym Membership Registration Form

Please complete all required information below.
Are you a new member or an existing member?
If you are a current, existing member, what is your current key number/numbers?
(this is necessary so we can reprogram your key to the new system)
Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Single Monthly

Only allows that member to enter the facility

$15.80 for each month

Single 6 Months

Only allows that member to enter the facility

$51.95 for each six months

Single 12 Months

Only allows that member to enter the facility

$103.33 for each year

Family Monthly

Allows immediate family only to enter

$26.13 for each month

Family 6 Months

Allows immediate family only to enter

$119.10 for each six months

Family 12 Months

Allows immediate family only to enter

$206.63 for each year

Senior Monthly

$7.53 for each month

Senior Monthly

$41.62 for each month

Senior 12 Months

$82.94 for each year

Online memberships are required to sign up on autopay. It is the members responsibility to end autopay when membership is no longer desired.

All members will follow posted age restrictions.
Signature
Signature Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
If you are seen or suspected of breaking any of the LRC rules regarding your gym membership your key will be turned off and membership revoked immediatly with out refund.
Should be Empty:

Gym Membership Registration Form