Chuckit Application

 Just bring along to a workout or mail to:

 Chuck Bartlett
 3217 West Valley HWY N.
 Auburn WA 98001
 
Make Check Payable to Chuck Bartlett or pay online by clicking one of the buttons (right). If you pay online just circle which one you used and     bring the completed application along with you.

Yearly membership Plan
$225

 pay online >>

6 Months New Member $150.00

 Pay online>>

6 Months Returning Member $125.00

 Pay online>>

Monthly Member
$ 25.00
(online only, this a recurring charge, you'll be charged monthly )

 Pay online>>

Chuckit Application

Name:_____________________________________


Address: _________________________________________________

Phone:_____________________________________

E-mail:_____________________________________

Goals:______________________________________


Membership is good for 6 months from this Date:____________________

In consideration of the acceptance of the application, I for my heirs, executors, administrators and assigns, waive, release and discharge any and all rights and claims or damages against Chuck Bartlett, Super Jock n’ Jill and the Redmond Athletic Club. I assume those risks and will pay my own emergency expenses in the event of an accident, illness or other incapacity, regardless of whether I have authorized such expenses. I am physically fit and sufficiently trained for this program. I have read the information provided and certify my compliance by my signature.

_________________________________________________________________________
Signature                                                                                Date