Sign up - V3 MMA Membership Form

Member Details

* Required field

* First name

* Last name

Gender

* Phone Number Add secondary Phone +

Secondary Phone

* Email Address

Add secondary Email +

Secondary Email Address

* Date of birth

Subscribe to SMS updates

Message frequency may vary. Standard message and data rates may apply. Reply STOP to opt out. Reply HELP for help. Your mobile information will not be sold or shared with third parties for promotional or marketing purposes.

* Parent/Guardian's name

Address

* Street address

* City

* Zip / Postal code

* State

Country

Contacts

* Required field

* Contact Name

* Phone Number

Relation

Additional Contact

Photo

Edit Photo

Drag to reposition photo

Zoom

Rotate

Delete Photo Apply

Capture from camera No camera found. Please connect a camera to use this feature. Upload or use camera Upload photo

Membership

Apply Discount

Select
1. Silver Monthly Membership

Duration Ongoing
Access Unlimited
Cost $129.00 / month + 7% Tax
Programs MMA Fitness
Select
2. Gold Monthly Membership (Includes 4 Private 1 on 1 Sessions per Month)

Duration Ongoing
Access Unlimited
Cost $349.00 / month + 7% Tax
Programs MMA Fitness, Private Coaching
Select
3. Two Week Starter Package

Duration 2 weeks
Access Unlimited
Cost $59.00 + 7% Tax
Programs MMA Fitness
Select
4. Private 1 on 1 Training (4 Sessions)

Duration 1 month
Access 4 sessions
Cost $239.00 + 7% Tax
Programs Private Coaching
Select
5. Kids MMA Program

Duration Ongoing
Access Unlimited
Cost $149.00 / month + 7% Tax
Programs Kids Program

Membership Documents

Medical Conditions

Known Medical Conditions

How did you hear about us?

Who referred the member to us?

More details:

Account Password

Please pick a password to log-in to your account later.

Password (minimum 8 characters)

Confirm Password

Payment

Select membership first

Credit Card All transactions are secure and encrypted

Name on card

Payment Card

Payment will be provided later.

V3 MMA Membership Form