Club Midwest Hour Membership Agreement

check one:
3 months RECURRING ($180 prepaid)  _____
3 months NON-RECURRING ($195 prepaid) _____
6 months ($60 monthly) _____
12 months ($55 monthly) _____

1. Clients may choose a membership with commitment periods of(3) months (prepaid), (6) months (recurring) or (12) months
(recurring).  12-month members receive a free one-hour gift certificate at sign-up.  3-month memberships are prepaid ($180 for
recurring or $195 for non-recurring). 6 and 12-month memberships are billed monthly. Each month of membership includes a
complimentary 1hr Massage & 15 Minute session in our FAR Infrared Sauna – (conducted at Massage Midwest offices only)
2. Members’ Dues are paid with a valid current credit card for automatic monthly withdrawal (recurring billing).Late fee:  If Massage
Midwest is unable to collect your monthly dues from this source for any reason within five days of due date, Massage Midwest will
assess a $15 late fee penalty. Note: A $10 fee will be applied for each credit card denial. It is up to the member to keep credit card
information updated.         Initial _________
3. All memberships will continue as recurring from month to month after commitment ending date except Three-month non-recurring
members.  Members may cancel their membership after the first recurred billing date following the commitment ending date with 30-
days written notice.  Upon expiration or cancellation, unused complimentary massages are lost
and have no cash value.         Initial _________
4. Twelve-month memberships must be in effect for at least six months, after which, a fee of $75 will be charged for early
cancellation. Three-Month & Six-Month memberships may not be cancelled.  Cancellation request must be in writing. Return all
requests to Massage Midwest. (Fees and/or prices subject to change after commitment end date.)         Initial _________
5. Membership is valid only for member listed and cannot be transferred or used by anyone other than member.       Initial _________
6. Your current monthly membership fee must be paid in full to receive complimentary monthly massages.
7. Management has the right to terminate this agreement at any time.

Date: _______________ Commitment ending date: _______________ Recurring billing date:_______________
LAST name: _____________________________ FIRST name: ______________________________________
Address: ________________________________________________________________________________
City: ______________________________________ State : _______ Zip: ____________
Home phone: ____________________ Work phone: _____________________Cell: _______________________
E-mail Address: ________________________________________________
Credit Card Number: (Visa) (Mastercard) (Amex)____________________________________________________
Exp. Date: _________/_________ Digit Code (3 or 4 digits on back or front)________________________________  


Membership Benefits:

Each monthly membership fee entitles the member to one complimentary one-hour massage / sauna session. Prepaid
members may use Complimentary massages any time during membership. Unused free massages transfer each month of
membership. The hour massage cannot be split.  Add-on rates for guest and gift certificates for this agreement, are as follows:

30 minutes (massage) - $30
60 minutes (massage / sauna) - $50
Ionic Detox Foot Bath - $25
Ear Candling - $20

* Members may purchase unlimited massages for themselves but their guests and gift certificates are limited to two(2)/ month.     
Initial _________

24 hours notice required for cancellations or member will forfeit free massage.     Initial _________

Membership Plus:
Date: ___________________ Person for add-on: _________________________________________________________

The plus feature is added to the original Massage Midwest membership agreement for a period of not less than three (3)
months. The plus feature allows primary member to share membership privileges with one other member who is living in the
same household.  Member privileges transfer between the primary and the add-on member only. Only the primary or the add-on
member may use the one free monthly massage. During the membership term, both member and add-on may purchase unlimited
massages for themselves, and they may purchase massages for their guest and gift certificates at membership pricing. Member
guest and gift certificates are limited to no more than two (2) occurrences for any person in a six (6) month period per primary
membership.

By my signature below, I agree with the terms of this agreement.
Signature _________________________________


Management has the right to terminate this agreement at any time.