Nelspruit Boxing Club Membership Application, Idemnity (3) 2

Nelspruit Boxing Club Application For Membership
Full Name:
Gender:
ID Number: Age:
Cell Number:
Email:
Address:
Occupation:
Employer:
Salary Date:
Marital Status:
No. Of Dependants: Ages:
Emergency No.
Weight
Height
Health Ave Good Excellent Illness
Medical Conditions
Others Gyms, Clubs etc
YOUR AIM IN JOINING

BOXING
Signature________________
Date ________________
PREFFERED DAYS FOR YOUR SESSIONS ARE MON & WED OR TUE & THU
12 6 3
Monday - Thursday Roster Months Months Months
Training 1 05:00 – 06:00 Early Riser - Supervised Self Train R500pm R580pm R700pm
Preference 2 06:00 – 07:00 Early Riser - Supervised Self Train R500pm R580pm R700pm
3 07:00 - 08:00 Early Riser - Supervised Self Train R500pm R580pm R700pm
4 08:15 – 09:15 Exclusive Coaching - 4-6 members R700pm R800pm R900pm
5 09:30 - 10:30 Exclusive Coaching - 4-6 members R700pm R800pm R900pm
6 10:45 - 11:45 Exclusive Coaching - 4-6 members R700m R800pm R900pm
7 12:00 - 13:00 Lunch Bout - Supervised Self Train R500pm R580pm R700pm
8 13:00 - 14:00 Lunch Bout - Supervised Self Train R500pm R580pm R700pm
9 14:15 - 15:00 UNDER 12 Lightweights R500pm R580pm R700pm
10 15:30 - 16:30 OVER 12 Lightweights R500pm R580pm R700pm
11 17:00 - 18:00 BOXERCISE R500pm R580pm R700pm
12 18:00 - 19:00 BOXERCISE R500pm R580pm R700pm
13 19:00 - 21:00 Contender Boxing R500pm R580pm R700pm
I acknowledge and understand that I have to pay a R500 joining fee.

1.Preferred Training Days - Mon/Wed or Tue/Thu.
Additional Sessions - Friday (05:00 – 14:00) ARE available ON REQUEST / Prices below
Additional Sessions - Saturday (05:00 – 13:00) ARE available ON REQUEST / Prices below
Additional
Friday Roster Fee.
Training 1 05:00 – 06:00 Early Riser - Supervised Self Train R250 p/m
Preference 2 06:00 – 07:00 Early Riser - Supervised Self Train R250 p/m
3 07:00 - 08:00 Early Riser - Supervised Self Train R250 p/m
4 08:15 – 09:15 Exclusive Coaching - 4-6 members R350 p/m
5 09:30 - 10:30 Exclusive Coaching - 4-6 members R350 p/m
6 10:45 - 11:45 Exclusive Coaching - 4-6 members R350 p/m
7 12:00 - 13:00 Lunch Bout - Supervised Self Train R250 p/m
8 13:00 - 14:00 Lunch Bout - Supervised Self Train R250 p/m
Additional
Saturday Roster Fee.
Training 1 05:00 – 06:00 Early Riser - Supervised Self Train R250 p/m
Preference 2 06:00 – 07:00 Early Riser - Supervised Self Train R250 p/m
3 07:00 - 08:00 Early Riser - Supervised Self Train R250 p/m
4 08:15 – 09:15 BOXERCISE R250 p/m
5 09:30 - 12:30 Contender Boxing R250 p/m
Tick WHITE PRICE/MONTH boxes of choice and place initial here.

MEMBERSHIP
I, the undersigned, hereby confirm that the information provided by me and contained in this
membership agreement is correct and further confirm that I have read, understood and accept
the terms and conditions of members which are attached hereto. I further warrant that I am
medically fit to proceed with the normal routine of exercise and accept that it is my responsibility
to seek medical advice before participating in any program or class offered by Nelspruit Boxing
Club. I/We hereby agree to the annual change adjustments of the debit order to account for
annual increases of 8% - 10% in subscriptions on the 1st September each year.
Any person who participates in Nelspruit Boxing Club activities and/or services provided by any of
the coaches shall do so at his or her own risk. He or She shall assume all risk involved, sustained
while participating. Nelspruit Boxing Club and / or any coaches will not be held liable for any
misfortune that may occur. By signing below, you are certifying that you are in good health and have
consulted a doctor before beginning this or any other exercise program. This enrolment and
Indemnity form will remain valid regardless of venue changes. My legal signature below confirms the
aforementioned statements.
Signature:
Date:
Member Payment Details
Payments to made via EFT to:

Nelspruit Boxing Club
Capitec Bank
Savings Account no… 1533319357
REF – Initials and Surname
Proof of Payment mailed to [email protected]
Payments are in advance and to reflect by 1st of the following month to

ensure access to the Gym.
Members may elect to load stop order on their own account to the account above for the duration of their
contract with Nelspruit Boxing Club.
Full Names: ____________________________________________________________________
Identity Number: _________________________________________________________________
Date: ____________________
Signature: _________________
CANCELATION POLICY
A STRICT ONE MONTH NOTICE PERIOD (NOT LESS THAN 20 WORKING DAYS) IS REQUIRED.
THE NOTICE MUST BE IN WRITING. THIS IS REQUIRED FOR ALL CONTRACTS (3-6-12 MONTH
AGREEMENTS) THE NOTICE MUST BE GIVEN BEFORE THE FORMAL CANCELLATION WILL APPLY
Contracts will continue to be debited on a month-to-month basis until written cancellation is

received. A cancellation fee of 50% of the remaining value of the cancelled contract will be debited
to the members account upon cancellation of the debit order, payable together with the notice
period change.
I/We agree that although this Authority and Mandate may be cancelled by me / us, such
cancellation will not cancel the agreement. I/We shall not be entitled to any refund amounts
which you have withdrawn while this authority was active.
EG: If you cancel the 12-month contract in the month of June, you will pay the 1 month
notice as per normal of R500 for the last month of training (July) and a cancellation fee of
50% of the remaining value of canceled contract. 5 Months (August - December) x 50 / 2 =
R1250.00 + R500 = R1750
Full Name_____________________________________________
Date:
Signature:
Special Conditions
Should the premises at any time during the currency of this agreement be damaged or destroyed or if access is
prevented by a vis major, casus fortuitous or any other cause outside of the control of Nelspruit Boxing Club, the club
will continue its obligation in terms of this agreement at an alternative venue or via electronic media.
Signature:
------------------------------------------------------------------------------------------------------------------------------------------
COMPLETED DOCUMENTS TO BE HANDED TO OWNER OR COACH OR EMAILED TO
[email protected]
WHATSAPP US ON 082 396 0103
Applicant will be notified of outcome within 10 – 14 days.

Nelspruit Boxing Club Membership Application, Idemnity (3) 2

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Nelspruit Boxing Club Application For Membership

No. Of Dependants: Ages:

Others Gyms, Clubs etc

YOUR AIM IN JOINING

I acknowledge and understand that I have to pay a R500 joining fee.

Tick WHITE PRICE/MONTH boxes of choice and place initial here.

Member Payment Details

Payments to made via EFT to:

Payments are in advance and to reflect by 1st of the following month to

Full Names: ____________________________________________________________________

Identity Number: _________________________________________________________________

Contracts will continue to be debited on a month-to-month basis until written cancellation is

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