Membership AgreementMember First NameMember Last NameMember AddressAddress Line 1Address Line 2CityStateZip CodeCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)RomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwePhone No.Member EmailMembership Type- Select -Single MembershipCouple Gym MembershipFamily MembershipSenior Citizen MembershipMilitary, FF, FR, Teacher MembershipWest Marshall MembershipTotal Membership FeeMonthly or Annual PaymentTERMS AND CONDITIONS: Authorization for Electronic Funds Transfer or Credit Card Payment. Member hereby authorizes its bank or credit card company to make payment for the Membership Fee, including, but not limited to monthly dues, any unpaid past dues, and any other fees, taxes or charges from the account provided on the reverse side of this page. Member agrees to pay a fee of $____, and when applicable, a late charge as well as any other charges allowed by law for any EFT or credit card charge not honored by Member’s bank or credit card company. Membership Access. In consideration of the Membership Fee, Member is entitled to enter the premises located at 101-103 E. Main Street, State Center, Iowa, and enjoy the use and benefit of the facilities of State Center Fitness, or the portion thereof connected to Member’s Membership Type (collectively, the "Facility"). Member agrees not to allow any other person(s) access to the Facility along with Member. Should Member violate any conditions of this provision, the membership may be revoked with no refund, and criminal prosecution may be applicable. Membership Term & Cancellation. This is a continuous membership plan. If Member desires to terminate or change the membership in any way, the Member must give State Center Fitness, 30 days’ written notice. No prorations of membership fees for partial months will be provided. Default-Remedies. Any payment required under this Membership Agreement, which is received more than ten (10) days after the due date shall be subject to a late fee of $____. Additionally, State Center Fitness, may suspend or terminate Member’s membership at any time if, in its sole discretion, Member violates any term or condition of this Membership Agreement. Membership Identification. Members understand that they may be required to provide proof of membership upon entry to the facility. Inclement Weather Closings. Member understands that in addition to the regular business hours, State Center Fitness, may, in its sole discretion, close the facility from time to time due to inclement weather. Rules Incorporated. Member understand and acknowledges that State Center Fitness, LLC has provided a list of rules related to Member’s use of the Facility (“Rules”). The Rules, as amended from time to time, are incorporated herein by reference and Member agrees to be bound by the same. Release & Waiver. All Members are urged to obtain a physical examination from a doctor before using the Facility, the tanning beds at the Facility, or participating in any exercise regimen. All use of the Facility, the tanning beds, and exercises, including the use of weights and use of any and all machinery, equipment and apparatus designed for exercising shall be at the Member's sole risk. Member understands that the agreement to use the Facility, tanning beds, or selection of exercise programs, methods and types of equipment shall be Member's entire responsibility, and State Center Fitness, shall not be liable to Member for any claims, demands, injuries, damages or actions arising due to injury to Member's person or property arising out of or in connection with the use by Member of the Facility, services, facilities, and premises of State Center Fitness. Member hereby holds State Center Fitness, its members, officers, owners, agents and employees harmless from all claims which may be brought against them by Member or on Member's behalf for any such injuries or claims. This agreement is not effective until Member and an authorized representative of State Center Fitness, sign and date it. Member should not sign this Membership Agreement before Member reads it or if it contains any blank spaces to be filled in. Member acknowledges that Member has read front and back pages and received a completed copy of this agreement in compliance with federal and state law. First NameLast NameDateSubmit Form