Membership Renewal Form Do you know your membership number?* Yes No Your membership number will be on your swipe car. Card Number*Please enter your membership number as it reads on your card. Name* First Last Email* Date of Birth* DD slash MM slash YYYY Membership Term1 month - $803 months - $2106 months - $31512 months - $525Direct Debit - $15.50/pwDo you need a replacement card?* Yes No Card Fee* Price: Coupon CodeTotal $ 0.00 Weekly Payment Total $ 0.00 PaymentOur team will contact you to arrange your Direct Debit. PaymentPlease select your method of payment* Pay Now (online via PayPal) Pay Later (our team will contact you to arrange payment) Terms and Conditions* I agree to the terms and conditions By checking this box I acknowledge that I understand what is included with my membership at Lyfestyle24 Hervey Bay, that I am physically and medically fit to undertake a basic exercise program and I am over 16 years of age. I have read, understood & hereby agree to the terms and conditions of membership as set out in Terms & Conditions and the terms and conditions of this promotion; One purchase per person only, Membership must be commenced before 24th December 2017, Not to be used in conjunction with any other promotions or discounted memberships.