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Membership Agreement + Direct Transfer of Membership Dues

* Indicates required field

Name *

First

Last

Email *

Phone Number *

How did you hear about Latitude 44 Yoga Studio? *

Facebook / Instagram (@latitude44yoga) Google A friend/family member ( Referral**, see below) Other

If you were referred by a friend/family/staff member, who referred you? *

I want to *

Sign-up as a NEW member CHANGE my membership type (I am currently a Member) - 30 day notice required Update my payment method

Preferred Membership Start/Change Date (MM/DD/20YY) *

Membership Selection *

Unlimited Membership (Reg. $99/month) Unlimited ANNUAL Membership ($999 for 12 months) 9x/Month Membership ($74/month) 5x/Month Membership ($50/month) Online LIVE + On-Demand ($54/month) On-Demand ($34/month) "Name Your Rate" Karma Membership

SPECIAL CONSIDERATIONS? This will include details for the Name Your Rate Karma Membership & discounts applied from 14 day trial attendance. Please note if you are CHANGING your membership, your 14 day trial discount does NOT carry over.

Special Considerations *

Paying via... *

Credit Card (+5% Credit Card Surcharge) Checking/Savings (ACH direct transfer)

I understand that my monthly membership AUTO-RENEWS on the same date each month. Annual memberships do NOT auto-renew and you must sign up again each year. *

Yes, I understand.

I understand I must provide a 30 day notice to CANCEL via the online cancellation document available upon request. Annual memberships ($999) do not require a cancellation as they do not auto-renew. Membership dues are not pro-rated. *

Yes, I understand.

I understand that if I am on a 5x or 9x Membership, my unused classes do not roll over from month to month. *

Yes, I understand. Not applicable (I am on an Unlimited membership).

I authorize Latitude 44 Yoga Studio, LLC to transfer funds from my bank account to cover monthly expenses related to my membership dues as well as make any adjustments for any debit entry errors to my account. If funds are not available in my bank account, I authorize Latitude 44 Yoga Studio to utilize my credit card that is on file to cover these expenses. Latitude 44 Yoga Studio reserves the right to charge $15 per incident for any EFT reclear fee, unpaid EFT draft, declined credit or debit card, unpaid credit card chargeback, or late payment. [Electronic Signature] *

Submit

313 E. Madison Street
Eau Claire, Wisconsin 54703
Studio: (715) 828-3936
Email: info(at)latitude44yoga.com
Facebook @latitude44yoga
Instagram @latitude44yoga

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