65 Years and Over Membership Subscription

Please enter information on the form below to process membership for 65 Years and Over Membership. The price you have to pay is $50.00.

Username*

Password*

Retype Password *

First Name *

Last Name *

Gender *

Address *

Address2

Suburb *

State *

Postcode *

Date of Birth *

Mobile Phone *

Email *

What gym do you train at?

Message

CODE OF CONDUCT *

WPC RULE BOOK *

Payment Terms

$50.00 for each 1 year

Regular subscription price

Regular subscription discount amount

Regular subscription tax

Payment Fee

Regular gross amount

Payment Method

Paypal

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

Existing user? Please login