Complete the form below and proceed to checkout to begin your membership at the Breakthrough FamilyPlex Fitness Center today! Thanks for signing up for monthly auto-pay for your membership fees. To show our appreciation, we're giving you 10% off our normal rates!

Please click here to download and read our Fitness Center Member Agreement before proceeding. A copy of this document will also be emailed to you after checkout.


Contact Information

First Name
Last Name
Email
Address
City
Country
State/Province
Postal Code

Additional Information

Current Age
Date of Birth
Occupation
Employer
Work Phone
Mobile Phone
Other Phone
Preferred Phone
 
Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Daytime Phone
Emergency Contact Evening Phone
 
Family Member 2 Name
Member 2 DOB
Family Member 3 Name
Member 3 DOB
Family Member 4 Name
Member 4 DOB
 
I acknowledge that I have downloaded and read a copy of the Fitness Center Membership Agreement. A copy of the agreement will also be sent to me after checkout.
I agree to adhere to the Rules and Guidelines as outlined in the Membership Agreement.
I acknowledge that Breakthrough may use my email and phone information only for communication regarding my membership status and benefits.
I acknowledge that membership rates are guaranteed for my first 12 months. Rates are subject to change thereafter with 30 days’ notice.
By proceeding, I acknowledge that my account will be charged for the first month of my membership. My account will automatically be debited monthly hereafter for my membership until I give notice to terminate.