Shredded – Membership Form

Membership Form for Shredded Health & Performance

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Membership Details

Full Name
Birth Date:*
Residential Address:*
Emergency Contacts Details
How did you hear about us?*
Please provide the full name of the person who referred you to Shredded.

Membership Details

12 Week Membership*

12 Month Membership*

Membership Add On – Optional

Please kindly check the box if you would like to include Unlimited access to our Infrared Sauna & Ice Bath. This is an additional $27 per week to your above membership choice.
Fire & Ice Membership Add On*

Payment Information and Authorisation.

By providing your payment details and confirming your method of payment, you agree to the fee associated with your chosen method of payment and this Direct Debit Request and the Direct Debit Request service agreement*. Direct Debit Request service agreement, and authorise Stripe Payments Australia Pty Ltd ACN 160 180 343 Direct Debit User ID number 507156 (“Stripe”) to debit your account through the Bulk Electronic Clearing System (BECS) on behalf of Shredded Health & Performance for any amounts separately communicated to you by the Merchant.
Payments Authorisation*
Name as displayed on Card.
16 Digit Card Number

Terms & Conditions

Fire & Ice

Terms & Conditions of use for the Ice Bath & Infrared Sauna Facilities at Shredded Health & Performance.
By signing this form, I hereby acknowledge my membership agreement at Shredded Health & Performance. This includes, all terms and conditions, as well as the assumed risk and liability outlined above.
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