Membership form

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Network Elite Club Membership

If you're renewing, just use the same email address as previously and your Membership will link to your existing Member records.

Membership form – Elite Club membership
Company
First Name*
Last Name*
Qualification Level*	Certificate III - Aqua Instructor Certificate III - Group Exercise Certificate III - Gym Instructor Certificate IV - Personal Trainer Certificate IV or Diploma in Massage Diploma of Fitness Les Mills Group Exercise Leader (GEL) N/A Other Student University Degree in Exercise Science or Related University Degree in Health Related Profession
Date of Birth*
Gender*	Male Female
Address*
Suburb*
State	-select here- ACT Auckland Bay of Plenty Canterbury Gisborne Hawkes Bay Manawatu-Wanganui Marlborough Nelson Northland NSW NT Otago Other QLD SA Southland Taranaki TAS Tasman VIC WA waikato Wellington West Coast
Post Code*
Country*	-select here- AUSTRALIA NEW ZEALAND
Email*
Work Phone
Mobile Phone*
Payment details
Membership Cost	$299
Credit Card Holder Title*	-- select title -- Mr. Ms. Mrs. Miss Dr. Sir Prof.
Credit Card Holder Name*
Credit Card Number*
Expiry Date*	-- 01 02 03 04 05 06 07 08 09 10 11 12  /  ---- 2017 2018 2019 2020 2021 2022
CVV/CVV2 Code*
Working, please wait...     Please note: that by default all memberships renew automatically every 12 months. After submitting this form you will receive a welcome email which will include a link to 'opt-out- of the automatic renewal. We hope you enjoy your Network membership!

Speak to Us1300 493 832

Email usinfo@fitnessnetwork.com.au