PLATINUM PLAN ENROLLMENT FAMILY PLATINUM PLAN - FAMILY $179 Get Enrolled Today ! Fill out the form below to enroll in the Family Platinum Plan. Get started today! CONTACT US IF YOU HAVE ANY QUESTIONS: (678) 819-5497 SCHEDULE APPOINTMENT: Book Here ENTER FAMILY MEMBER NAMES Enter names for each family member. Minimum of 2 family members required for Family Platinum Plan. Family Member #1 - Full Name * First Last Family Member #2 - Full Name * First Last Family Member #3 - Full Name First Last Family Member #4 - Full Name First Last Family Member #5 - Full Name First Last DATE OF BIRTH Enter birthday for each family member. Minimum of 2 family members required for Family Platinum Plan. Date of Birth Family Member #1 * Date of Birth Family Member #2 * Date of Birth Family Member #3 Date of Birth Family Member #4 Date of Birth Family Member #5 ENTER GENDER OF FAMILY MEMBERS Enter the gender for each family member. Minimum of 2 family members required for Family Platinum Plan. Sex - Family Member #1 * — Select — Male Female Other Sex - Family Member #2 * — Select — Male Female Other Sex - Family Member #3 — Select — Male Female Other Sex - Family Member #4 — Select — Male Female Other Sex - Family Member #5 — Select — Male Female Other Address * City * State * Phone # * Email * Family Sports Acitvities - select all that apply for all family members Football Basketball Baseball Golf Soccer Hockey Runner Swimmer Strength Training Cardio Training Other Comments