Monthly Auto Renew Membership Registration

Use the Form Below to Register Your Monthly Auto-Renew Membership.

"*" indicates required fields

Name*

First Last

Phone*

Email*

Enter Email Confirm Email

Address*

Street Address Address Line 2 City Postal Code

Your Birthdate*

Consent*

I have read and I agree to the Wilkie Wellness Terms & Conditions

Waiver*

I have read and I agree to the Wilkie Wellness Gym Waiver

Monthly Membership - Auto Renew

Price:

GST - 5%

Price: $ 0.00 CAD

Total

Securely pay with your credit card using Square^TM

Credit Card

Cardholder Name

Card Details

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