Online Membership Registration

	Membership Type:	STANDARD

	Enrollment Fee:	$39.00

	Prorated First Month Dues:	$5.31

	Last Month Dues:	$10.70

	Total Due Today:	$55.01

M E M B E R I N F O R M A T I O N


First Name	MI
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M E M B E R B I L L I N G I N F O R M A T I O N

Billing Information for Today's Payment

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Monthly Recurring Billing Information


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B I L L I N G F O R M E M B E R S H I P


	NOTICE OF DUES RENEWAL: Membership is automatically renewed at the end of the initial obligation. If you wish to discontinue your Month-to-Month membership you may do so at any time with a payment of a twenty-five (25) dollar processing fee that is due upon membership termination and surrendering your membership card. Your processing fee payment may be provided at the club or mailed via certified mail to your RealTime Fitness Center location. In order to discontinue billing RealTime Fitness requires at least ten business days written notice prior to the end of the initial obligation.
	ANNUAL RATE GUARANTEE FEE: By checking this box, I agree to a once-a-year fee of $34.99 will be billed approximately 90 days from the membership join date, to the billing account on file.
	I wish to make my payments to Real Time Fitness through its Pre-Authorization Payment Program. I hereby authorize my bank or credit card company to make my payment for monthly dues, any unpaid past dues, and and other fees, taxes or charges from the account I used to pay for the Total Due Today or from the account shown above. Your account will be billed on or around the 1st day of the month until you cancel in accordance with this Agreement. I agree to pay a service fee of $10.00 as well as any other charges allowed by law for any EFT or credit card charge not honored by my bank or credit card company. I understand that Real Time Fitness may, upon written notice, change the date that my monthly dues are debited from my account.

M E M B E R S H I P T E R M S

I understand that I have signed a contract/note/agreement. My failure to regularly attend and utilize center facilities does not relieve my obligations, regardless of the circumstances, to pay the installment note in full.  Should I default I agree to pay all cost of collection including, but not limited to Collection Agency fees up to 50% of the unpaid balance, court cost, and reasonable attorney fees. All of which may be paid or incurred by the holder of this note.

EFT Request Buyer (individually and as agent or guardian of member) hereby authorizes RealTime Fitness and/or its agents to make periodic charges to or withdrawals from the account used to pay the initial payment described above or the account designated below or replacement hereafter for payment of any sums due RealTime Fitness and/or its’ agents facilities or services (the “EFT”), as follows.  Buyer waives the right to receive prior notice for charges or withdrawals made with respect to any uncollected monthly dues, payments or portions of the balance due described on this agreement on the corresponding transfer of the sole responsibility of the buyer.  Buyer understands that the buyer is in full control of the buyer’s payment in that this EFT authorization will remain in effect until RealTime Fitness and/or its agents receive written notice via certified mail of termination of this agreement as allowed by this agreement and has a reasonable opportunity to act on that notice. If you decide to change your billing information, a five day notice is required.  Such notification will not otherwise effect this agreement and buyer’s obligation herein.

Any notice of intent to cancel given by the member to the club must be in written order to be effective.  Membership card must be presented upon admittance into club; such means of identification shall be provided through the club.  Such a notice of cancellation from the customer shall also terminate automatically any customer’s obligation to any entry to whom the health studio has subrogated or assigned the customers contract.  The initial agreement will not be for a period in excess of thirty-six months, and thereafter shall only be renewable annually. Such renewal agreements may not be executed and the fee therefore paid until sixty days or less before the preceding agreement expires.  This agreement is the initial terms stated above and is renewed automatically on a month to month basis.

You may cancel this agreement if you become physically unable to avail yourself of a substantial portion of the services which you use from the commencement of this agreement until the time of disability or upon your death, your estate may cancel this agreement; and such cancellation shall be authorized only upon you or your estate furnishing the club a certification of such disability by a licensed physician or certification of your death.

Subject to the following conditions:
(1)    The items shall be drawn on or about the date or dates of the payment schedule. The transactions on your bank statement will constitute receipts for payment on your account.
(2)    If the regular payments set forth on the payment schedule should vary in amount, you are entitled to notice at least 10 days before each payment of when it will be made and how much it will be. However, by executing this preauthorization, you choose to instead get this notice only when the payment would differ by more than $50.00 from the most recent payment.
(3)    By executing this agreement, you acknowledge your awareness that certain disclosures required by the electronic funds transfer act and its regulations are available for your review at the company’s website.
(4)    The privilege of making payments under this arrangement may be revoked by the company if any item is not paid upon presentation.
(5)    If this preauthorization payment arrangement is revoked for any reason, this does not release you from your obligation (Payment Schedule).
(6)    A service fee will be assessed and drafted for any check, draft, credit card, or order returned for insufficient funds or any other reason. A late fee will be assessed and drafted should any monthly payment become past due.
(7)    This preauthorization payment arrangement shall apply to the following applicant(s).
(8)    If buyer selects the Premium membership for $19.99/month and he/she wishes to terminate their membership a $60 cancellation fee will be assessed.

CONSUMER PROTECTION CLAUSES
A. The contract provides for the penalty-free cancellation of the contract within 3 days, exclusive of holidays and weekends, of its making, upon the mailing or delivery of written notice to the health studio, and refund upon such notice of all monies paid under the contract, except that the health studio may retain an amount computed by dividing the number of occasions health studio services are to be rendered into the total contract price and multiplying the result by the number of complete days that have passed since the making of the contract or, if appropriate, by the number of occasions that health studio services have been rendered. A refund shall be issued within thirty (30) days after receipt of the notice of cancellation made within the 3-day provision. [S. 501.017(1) (a), F.S.]
B. The contract provides that notice of intent to cancel by the buyer shall be given in writing to the health studio. Such a notice of cancellation from the consumer shall also terminate automatically the consumer's obligation to any entity to whom the health studio has subrogated or assigned the consumer's contract. If the health studio wishes to enforce such contract after receipt of such showing; it may request the Department to determine the sufficiency of the showing. 
		[S. 501.017(1) (b) 2, F.S.]
C. The contract provides that if the department determines that a refund is due the buyer, the refund shall be an amount computed by dividing the contract price by the number of weeks in the contract term and multiplying the result by the number of weeks remaining in the contract term. The business location of a health studio shall not be deemed out of business when temporarily closed for repair and renovation of the premises:
        1. Upon sale, for not more than fourteen (14) consecutive days; or
		DACS-10300 Rev. 08/10 page V of V.
        2. During ownership, for not more than seven (7) consecutive days and not more than two (2) periods of seven (7) consecutive days in any calendar year. A refund shall be issued within 30 days after receipt of the notice of cancellation made pursuant to this paragraph.
		[S. 501.017(1) (b) 3, F.S.]
D. The disclosure statement shall include a provision advising the buyer to contact the Department for information within sixty (60) days should the health studio go out of business. [S. 501.017(1) (c), F.S.]
E. If your contract is for thirty (30) days or less, without any option or other condition which establishes any right or obligation of a member beyond the thirty (30) day period then this provision should read as follows:
        The initial contract will not be for a period in excess of thirty (30) days. Renewal contracts may not be executed and the fee therefore paid until the preceding contract         expires.
If you sell SESSIONS in this manner then the contract must ALSO indicate that ALL sessions must be used within thirty (30) days. 110545
F. The contract provides that if the health studio requires a buyer to furnish identification upon entry to the facility and as a condition of using the services of the health studio, the health studio shall provide the buyer with the means of such identification. [S. 501.017(1) (f), F.S.] 
G. Health studios exempt from posting security must include in all contracts for health studio services the following disclosure statements [S. 501.017(2), F.S.]: 
        SHOULD YOU (THE BUYER) CHOOSE TO PAY FOR MORE THAN 1 MONTH OF THIS AGREEMENT IN ADVANCE, BE AWARE THAT YOU ARE PAYING FOR         FUTURE SERVICES AND MAY BE RISKING LOSS OF YOUR MONEY IN THE EVENT THIS HEALTH STUDIO AND/OR THISBUSINESS LOCATION CEASES         TO OPERATE. THIS HEALTH STUDIO IS NOT REQUIRED BY FLORIDA LAW TO PROVIDE ANY SECURITY, AND THERE MAY NOT BE OTHER         PROTECTIONS PROVIDED TO YOU SHOULD YOU CHOOSE TO PAY IN ADVANCE.
Please be aware contract form approvals are subject to subsequent changes in the law. Each year the health studio is required to submit the contract form(s) currently in use with the annual renewal application.

I have read the membership terms and accept them