Urban Fitness Outdoor SA Sign Up Form

Your Name

Your Surname

Email Address

Date of Birth (DD/MM/YYYY)

ID Number

Postal Address

Cell Number

City

Occupation

Main Venue

Package

If you are joining on Couples or Buddies Unlimited, please add the others persons name here

Where did you hear about Urban Fitness Outdoor SA?

If you selected Word of Mouth, who referred you?

Medical Aid

Medical Aid Number

Emergency Contact person

Emergency Contact person number

Method of Payment

Debit Date

*NOTE* If you selected Direct Debit we will be sending you the debit order authority link shortly.

I have read and agree to all the terms and conditions of membership with Urban Fitness Outdoor SA. Please ensure that you read the T&C's as they are an integral part of the smooth running of your membership.
 Yes

*Note* If you are joining in the month, a Pro-rata amount will be emailed to you for the rest of the amount. This amount can be added to your first bank debit