Enrollment Form: Kewanee warehouse

Member Details

First Name*

Last Name*

Gender

Phone Number*

Email*

Date of Birth

Insurance Provider*

Insurance Provider ID*

Address

Street Address*

City*

ZIP Code*

State*

Country*

Emergency Contact

First Name

Last Name

Phone Number

Billing Address

Same as home address

Street Address*

City*

ZIP Code*

State*

Country*

Select Membership

Memberships Sorted Alphabetically

10 Tans (use within 6 months)

6 months

10 sessions / payment

$40 / session

[TRIAL] Single Lift Pass

1 day

1 days / payment

$7 one-time

DESCRIPTION: Expires at Midnight of purchased day

[TRIAL] Single tan

1 day

1 days / payment

$7 one-time

[TRIAL] Week Pass

1 week

1 days / week

$20 one-time

Couples

ongoing

Unlimited

$70 / month +$20.00 one-time signup fee

Family of 2

ongoing

Unlimited

$70 / month +$20.00 one-time signup fee

Family of 3

ongoing

Unlimited

$90 / month +$20.00 one-time signup fee

Family of 4

ongoing

Unlimited

$110 / month +$20.00 one-time signup fee

GUARDIAN PLAN

10 years

1 days / payment

$0 / year

Monthly

ongoing

Unlimited

$40 / month +$20.00 one-time signup fee

Monthly Tanning/Gym Combo

ongoing

Unlimited

$70 / month +$20.00 one-time signup fee

Unlimited Monthly Tans

ongoing

Unlimited

$45 / month

Account Password

Password

too short

Confirm Password

Credit Card

All transactions are secure and encrypted

Card Number

Expiry Month

Expiry Year

CVV / CVC

Zip Code