» Yaralla Fitness Centre Direct Debit Application

Yaralla Fitness Centre Direct Debit Application

Title*
Name*
First Last
Home Telephone
Mobile*
Email*
Address*
Street Address Address Line 2 City State Postal Code
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 in Personal Training?
- Yes
- No
Gym Membership
Access to both the Yaralla Fitness Clinton and Yaralla Fitness South Gladstone are included in Gym Membership. Lifestyle membership is available for people 16 years and over.
Membership Type*
- Gym - Clinton and Gladstone
- Lifestyle Package
Costs Incurred
Once off payment
Sign On Fee: $99

Administration Fee: $15
Total Weekly Payment
$ 0.00
Terms & 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
I also understand that there is a minimum term of 3 months and I am required to provide a written cancellation one month prior to stopping my direct debit payments.
A team member will contact you to arrange weekly payments
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