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Membership
Details
Terms & Conditions
Payment
Confirmation
Your Personal Details
Club
Mitre 10 Mega Amberley Fitness Centre
First Name
Last Name
Date of Birth
Gender
Male
Female
Email
Password
Confirm Password
Cell Phone
Home Phone
Work Phone
Street
Suburb
City
State
Postal Code
Country
New Zealand
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Google Adwords
Leaflet Drop
Mall Promotion
Occupation
Emergency Contact
Name
Phone
Email
Relationship
Medical Information
Behavioural Information
Start Date
First Payment Date
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Membership
Adult Regular 6 months
Price
$351.00 Full Cost
Tag
$20.00
Promotion
$0.00 until
Account Credit
applied after signup
Membership Start Date
Membership Length
6 months
Prorated Upfront Fee
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