BUDDY SPECIAL ENROLLMENT FORM
Enrollment Period January 1-31st, 2016
Buddy #1 Name: ____________________________________________
☐ Current WLG Member ☐ New WLG Member (both cannot be current members)
Address ___________________________________________________
City_______________________________ State_______ ZIP ________
Card Holder Phone Number: ( ______) ________-____________
Card Holder’s Email __________________________________________
Please select your WLG Monthly Package:
☐ $109 – 25% = $81.75 Monday to Friday Unlimited
☐ $139 – 25% = $104.25 Monday to Saturday Unlimited
Start date: _____________
End date: ______________
Monthly payment method: ☐ Check ☐ Cash ☐ Charge (please fill out the
below information if charge is selected)
Billing Address same as above ☐ Yes ☐ No (please include billing address on
the back of page)
Card Number: ________________________________Exp Date: ______
CODE ON BACK OF CARD _______
☐ Please check here if you wish to enroll in an auto charge of your monthly
tuition. This is NOT A CONTRACT, however you must agree to 3 monthly
installments of your monthly tuition in order to receive the 25% discount.
Charges agreed upon above will appear on your credit card statement as
“Workout Like A Girl/Ai LLC”. By signing below you are agreeing to have the
monthly fee charged to the card above for a max of 3 months.
Card Holder Signature: __________________________Date: ___________
Card Holder Name (Print) ________________________________________
1
BUDDY SPECIAL ENROLLMENT FORM
Enrollment Period January 1-31st, 2016
Buddy #2 Name: ____________________________________________
☐ Current WLG Member ☐ New WLG Member (both cannot be current members)
Address ___________________________________________________
City_______________________________ State_______ ZIP ________
Card Holder Phone Number: ( ______) ________-____________
Card Holder’s Email __________________________________________
Please select your WLG Monthly Package:
☐ $109 – 25% = $81.75 Monday to Friday Unlimited
☐ $139 – 25% = $104.25 Monday to Saturday Unlimited
Start date: _____________
End date: ______________
Monthly payment method: ☐ Check ☐ Cash ☐ Charge (please fill out the
below information if charge is selected)
Billing Address same as above ☐ Yes ☐ No (please include billing address on
the back of page)
Card Number: ________________________________Exp Date: ______
CODE ON BACK OF CARD _______
☐ Please check here if you wish to enroll in an auto charge of your monthly
tuition. This is NOT A CONTRACT, however you must agree to 3 monthly
installments of your monthly tuition in order to receive the 25% discount.
Charges agreed upon above will appear on your credit card statement as
“Workout Like A Girl/Ai LLC”. By signing below you are agreeing to have the
monthly fee charged to the card above for a max of 3 months.
Card Holder Signature: __________________________Date: ___________
Card Holder Name (Print) ________________________________________
2