» Membership Application

Yaralla Fitness Centre Membership Application

Title*
Name*
First Last
Home Telephone
Mobile*
Email*
Address*
Street Address Address Line 2 City State Postal Code Country
Date Of Birth*
DD slash MM slash YYYY
Occupation
Emergency Contact Name*
Emergency Contact Number*
Please upload a photo of yourself for your membership card*
Max. file size: 300 MB.
Please supply a high resolution photo in JPG format. Please make sure you are not wearing a hat or sun glasses and there is no filter on the photo. Please wear a shirt in your photo.
Are you interested on Personal Training?
- Yes
- No
Gym Membership & Lifestyle Package
Please select either a one, three, six or twelve month membership
Access to both the Yaralla Fitness Clinton and Yaralla Fitness South Gladstone are included in Gym Membership

Student membership only applies to those between 12 and 18 years of age

Lifestyle membership is only available for 16 years and over
One Month Membership
Three Month Membership
Six Month Membership
Twelve Month Membership
Payment
Total
$ 0.00
Please select your method of payment:*
- Pay Now (online via Paypal)
- Pay Later (a team member will contact you to arrange payment)
Terms and Conditions*
- I agree to the terms and conditions
By checking this box I acknowledge that I understand what is included with my membership at Yaralla Fitness Centre and that I am physically and medically fit to undertake a basic exercise program. I have read, understood & hereby agree to the terms and conditions of membership as set out in Terms & Conditions
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