# 35/36, 1st Main road, Opposite to Kabir ashram K.S.Town, Bangalore - 560 060.

Tel:080-28482557

MEMBERSHIP APPLICATION FORM

CUSTOMER 1D NUMBER 1. NAME: MR! MRS! MS 2. FATHERS! HUSBANDS NAME 3. ADDRESS:

4. CONTACT TEL NUMBERS

OFF: MOBILE:

RES:

E-MAIL 10 5. AGE! DATE OF BIRTH 6. OCCUPATION 7. EMERGENCY CONTACT DETAILS: NAME: MOBILE: RELATIONSHIP: MALE FEMALE

8. PREVIOUS EXPERIENCE OF TRAINING IN A HEALTH CLUB

DAYS

NO

9. MEDICAL CONDITION DETAILS/ HISTORY, IF ANY:

PAYMENT DETAILS IPREFERRED:

REGISTRATION FEES: Rs......................................... MEMBERSHIP FEES : Rs...........................................

CASH / CARD / CHEQUE

YEARLY

MONTHLY

I hereby apply for membership and agree that I will respect the rules & regulations (mentioned overleaf) of the Health Quest, In the event of disrespect, my membership may be cancelled immediately and no claim for refund of membership fees, not even in part, will be made to me.

Signature of Staff - HQ

Signature of Customer

# 35/36, 1st Main road, Opposite to Kabir ashram K.S.Town, Bangalore - 560 060. Tel:080-28482557

MEMBERSHIP APPLICATION FORM

RULES & REGULATIONS FOR MEMBERS

READ THE FOLLOWING RULES & REGULATIONS TO ENSURE YOUR PHYSICAL & PERSONAL SAFETY.
1. 2. 3. 4. 5. 6. 7. 8. 9. The Management reserves the right to cancel or terminate a membership and reserves the right to admission to the club members. Membership is not transferable. Membership is not continuable & not extendable beyond due date. Membership must be renewed on or before due date. The management is not responsible for any loss of possessions in the premises. Members are requested not to leave any valuables in the premises. Member's will provide full compensation for any damages incurred by them. Casual wear, jeans, formals, sandals or casuals shoes are prohibited during workouts. Only sportwear are allowed. Practising martial arts is stictly prohibited in the premises.

10. Members will read & follow all the sign boards pertaining to the smooth functioning & safety of the Gymnasium. 11. Children below 10 years are not allowed inside the gym. 12. Smoking is strictly prohibited in the gym premises. 13. Members under the influence of alcohol are not permitted to work-out. 14. The club is not responsible for any member not disclosing his/her previous medical history, and no claim will be entertained on any personal injury to the members. 15. Club members are requested to follow the instructions only from the instructor .

For M/s. HEALTH QUEST

Authorised Signatory

Signature of the Member