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Please complete the contract below Please enable JavaScript in your browser to complete this form.Section A: Member Details - Step 1 of 4Name *FirstLastDate of Birth *Residential AddressMobile Number *Email *Emergency Contact Name *Emergency Contact Number *Branch *Select oneDiep RiverEdgemeadAre You Older Than 18? *Please selectYesNoGuardian DetailsID TypePlease selectSA IDNational IDPassportID / Passport Number *Date of Birth *ID Number *Guardian TypePlease selectFatherMotherBy court orderSurname on ID *Maiden Name (if applicable) *Mobile Number *Email *NextContract Term *Select oneMonth to Month6 Months12 MonthsTerm - 12 months *Group Basic (1 per week) - R525.00Group Boost (2 per week) - R640.00Group Max (unlimited) - R760.00Term - 6 months *Group Basic (1 per week) - R555.00Group Boost (2 per week) - R685.00Group Max (unlimited) - R815.00Term - Month to Month *Group Basic (1 per week) - R610.00Group Boost (2 per week) - R740.00Group Max (unlimited) - R880.00NextID Number (This is also your Contract Reference Number) *No spacesMember Name *Name of Bank *Bank Account Holder Name *Bank Account Type *Please select oneCheque=1Savings=2Transmission=3Branch Code *Bank Account Number *TotalR0.00NextI/We hereby authorise Netcash (Pty) Ltd to issue and deliver payment instructions to your banker for collection against my/our above mentioned account at my/our abovementioned bank on condition that the sum of such payment instructions will not differ from my/our obligations as agreed to in the Contract Reference Number (ID number). The individual payment instructions so authorised must be issued and delivered on the date when the obligation in terms of the Agreement is due and the amount of each individual payment instruction may not differ as agreed to in terms of the Agreement. The payment instructions so authorised to be issued must carry the Contract Reference Number, included in the said payment instructions, and must be provided to identify the specific contract. The said Contract Reference Number should be added to this form in section E before the issuing of any payment instruction and communicated directly after having been completed. I /we agree that payments will be delivered regularly on theMonthly Debit Order Date *Please select one1st of month15th of month27th of monthof each month.If however, the date of the payment instruction falls on a non-processing day (weekend or public holiday) I agree that the payment instruction may be debited against my account on the following business day; or Subsequent payment instructions will continue to be delivered in terms of this authority until the obligations in terms of the Agreement have been paid or until this authority is cancelled by me/us by giving you notice in writing of not less than 2 calendar months and sent by prepaid registered post or delivered to your address indicated above. B. MANDATE I/we acknowledge that all payment instructions issued by you will be treated by my/our above mentioned bank as if the instructions had been issued by me/ us personally. C. CANCELLATION I/we agree that although this authority and mandate may be cancelled by me/us, such cancellation will not cancel the Agreement. I/we also understand that I/we cannot reclaim amounts, which have been withdrawn from my/our account (paid) in terms of this authority and mandate if such amounts were legally owing to you. D. ASSIGNMENT: I/We acknowledge that this authority may be ceded or assigned to a third party if the Agreement is also ceded or assigned to that third party. E. AGREEMENT REFERENCE NUMBERID Number (this is also your Agreement Reference Number) *F. ACKNOWLEDGEMENT I understand and acknowledge that my membership is subject to the full terms and conditions which can be viewed via the SN Boxing website. SN Boxing may cancel my membership if I do not comply with my contract. If this contract is in the name of my Minor Child, by signing as Parent/Legal Guardian, I confirm that I agree to the Terms and Conditions and Accept the Medical Risk and Disclaimer on behalf of the Minor Child as well. Medical Risk: Please carefully consider the following questions: Has a doctor ever said that you have a heart condition or any other chronic condition and recommended only medically supervised activity? Do you have chest pain brought on by physical activity? Have you developed chest pain in the last month? Have you on one or more occasions lost consciousness or fallen over as a result of dizziness? Has a doctor ever recommended medication for blood pressure or a heart condition? Are you aware, through your own experience or a doctor’s advice of any other physical reason (including pregnancy) that would prohibit you from exercising without medical supervision? Do you have a bone or joint problem that could be aggravated by the proposed physical activity? If you answered YES to any of these, we strongly recommend that you obtain medical clearance before starting to exercise. There are risks associated with exercising and using gym equipment which can result in serious injury and even death and you accept responsibility for such risks. We recommend that you seek medical advice before you start anew exercise regime and that you always exercise to a level that is appropriate, given my knowledge of my health and any medical advice that you have obtained. You accept all risk and responsibility for nutritional, exercise or any other advice or plans that may be recommended to you. Disclaimer: I understand and agree to the following disclaimer: To the fullest extent permitted by law, Steven Newton Boxing PTY Ltd, as the case may be, or any of their direct or indirect international affiliates who may give you access to their facilities as a result of this Contract, and/or their directors, employees and independent contractors (collectively, ‘Steve Newton Boxing’ or ‘SN Boxing’) shall not be liable for any loss or damage whatsoever and howsoever arising (including from any nutritional, exercise or any other advice) suffered by me or any of my dependents, including (without limitation) loss or damage to person or property from a negligent act or omission of SN Boxing, other members or guests. For the full Terms and Conditions, please click here.I agree to these Terms and Conditions *AgreePlease Sign Your Name *In acknowledgement of the above Terms and ConditionsSubmit
