Wellness Membership Signup

Please complete the following form to enroll in our Wellness Membership program.

Member's First & Last Name (or all members' names if Family Share Membership)	*
Street Address	*
City, State, ZIP	*
Mailing Address	*
City, State, ZIP	*
Email Address	*
Contact Phone Number	*
Membership Selection (Choose One)	*
Method of Payment	*
If you prefer, you may call our office with your credit card information at (207) 831-4182
Card Number	*
3 Digit Security Code	*
Expiration Date (mm/yy)	*
Authorization: I authorize Touchstone Bodyworks to automatically charge the credit card account indicated above on the 10th of each month to satisfy the full monthly payment for the Touchstone Bodyworks Wellness Membership option I have selected.
Please enter your initials in the box to indicate your authorization approval, allowing us to deduct the amount you have indicated from your account each month.	*
Cancellation Policy I understand that this agreement remains in effect, renewing automatically from month to month, until I provide a minimum of a 2 week advance written notice of cancellation, and that written cancellation must be received no later than the 26th of the calendar month to avoid having my account charged for the following month’s membership payment. I further understand it is not the policy of Touchstone Bodyworks to refund membership payment when written cancellation is received later than the 26th of the month, but instead the cancellation will become effective for the following month.
Please enter your initials in the box to indicate your acknowledgement of the Cancellation Policy of this agreement.	*
Effective Date of this Agreement (mm/dd/yy)	*
*(Upon clicking the "Submit Form" button, you will be redirected to our website)*