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Which branch are you interested in?(Required) Lynnwood Brooklyn Centurion Atterbury Personal DetailsYour Name(Required) Your Surname(Required) ID Number(Required) Your Email(Required) Mobile Number(Required)Address(Required) Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Next of Kin(Required) Next of Kin Contact(Required)PackagesPackage Options(Required) 3 x per Week Unlimited All Access Package Options(Required) Individual Couples 3x per week(Required) 12 Months - R900.00 6 Months - R975.00 Month-to-Month - R1075.00 3x per week (Couples)(Required) 12 Months - R1700.00 6 Months - R1850.00 Month-to-Month - R2050.00 Unlimited(Required) 12 Months - R1150.00 6 Months - R1325.00 Month-to-Month - R1425.00 Unlimited (Couples)(Required) 12 Months - R2100.00 6 Months - R2450.00 Month-to-Month - R2650.00 All Access(Required) 12 Months - R1350.00 6 Months - R1525.00 Month-to-Month - R1625.00 All Access (Couples)(Required) 12 Months - R2500.00 6 Months - R2850.00 Month-to-Month - R3050.00 Payment TypePayment Method(Required) Debit Order Banking DetailsAccount Holder Name(Required) Bank Name(Required) Branch Code(Required) Account Number(Required) Terms & Conditions(Required) Noted Month-to-Month agreements will require 30 calendar days' notice to cancel, no partial months. 6 and 12 months contracts must be honoured and the full amount outstanding will be paid upon termination. Cancellations must be sent to [email protected] Debit Order Date(Required) 1st 15th 27th Signature(Required)Date of Signature(Required) MM slash DD slash YYYY Consent(Required) I agree to the policy.Waiver and Release of Liability This form is an important legal document. It explains the risks you are assuming by partaking in the Willow Way training program. It is critical that you read and understand it completely. After you have done so, please print your name legibly and sign in the spaces provided. I, the undersigned, have volunteered to participate in a program of physical exercise under the direction of Willow Way Instructors, which will include but may not be limited to, weight and/or resistance training. In consideration of Willow Way’s agreement to instruct, assist, and train me, I do here and forever release and discharge and hereby hold Willow Way, harmless from any and all claims, demands, damages, rights to action, present or future, arising out of or connected with my participation in this or any exercise program including any injuries resulting therefore. I understand and am aware that strength, flexibility and aerobic exercise, including the use of equipment, is a potentially hazardous activity. I also understand that the fitness activities involve a risk of injury and even death, and that I am voluntarily participating in these activities and using equipment and machinery with knowledge of the dangers involved. I indemnify the Willow Way training methods and the premises in which the program is conducted, and I hold them harmless against any claims that may arise as a result of my participation in this program. I hereby agree to expressly assume and accept any and all risks of injury or death. I hereby further declare myself to be physically sound and suffering from no condition that would prevent my participation or use of machinery or equipment. I hereby further declare and take full responsibility for my children as their legal guardian and that I fully understand the risks of Willow Way. The use of equipment and physical exercise by individuals in the gym can potentially be hazardous to Children. Willow Way takes no responsibility and I hold them harmless against any claims that may arise. I accept all risks of injury or death. I hereby further declare that I have not had a physical examination and have chosen to participate. I hereby further declare that I will participate without the approval of my doctor and do hereby assume all responsibility for my participation and activities, and utilisation of machinery and equipment in my activities. I hereby indemnify Willow Way. I acknowledge that I have thoroughly read this waiver and release and fully understand that it is a release of liability. By signing this document, I am waiving any right my successors or I might have to bring a legal action or assert a claim against Willow Way. Use of pictures(s)/film/likeness: I agree to allow Willow Way, its agents, officers, principals, employees and volunteers to use picture(s), film and/or likeness of me for advertising purposes. In the event, I choose not to allow the use of the same for said purpose, I agree that I must inform Willow Way of this in writing.Authority to Debit Mandate:(Required) I agree to the authority to debit mandate.1st of every month: o As an authorised signatory of the bank account (or any other account to which I may transfer) I authorise Willow Way to debit the fees, associated amounts and/or monthly instalments for the duration of the Contract, unless reimbursed and/or paid for upfront by cash or card. o If this authority is cancelled, I acknowledge that such cancellation will not automatically cancel the Contract and I/the member will remain liable for payment. o I undertake to ensure that funds will be available and authorise Willow Way to re submit the debit and/or implement tracking on this account and collect funds as soon as they are available if the debit is unsuccessful. o I acknowledge that the bank may charge additional fees for re submission. o I acknowledge that I am not entitled to any refund while this authority is in force, if such amounts were legally owing to Willow Way. o I authorise Willow Way to disclose to any credit bureau any information concerning this credit profile and payment history. o the bank details provided must be for a bank branch within the Republic of South Africa. o If the payment falls on a Saturday, Sunday or recognised South African public holiday, the payment day will automatically be the very next ordinary business day. o The first debit will be determined by the start date of the membership and that subsequent debits will run on or about the dates chosen above. o I hereby further declare and understand that thirty (30) days’ notice must be given upon cancellation of my membership. Terms and Conditions(Required) I agree to Willow Way CrossFit terms and conditions.1. DURATION: This agreement commences on the commencement date and continues for the selected duration of the contract, upon expiry of the contract term the contract shall proceed as is if not renewed for a further/different term. 2. UNDERTAKINGS BY YOU: When you are required to provide Willow Way with details and personal information you undertake that it will be true, accurate and complete. You accept that the details and information which you have supplied and will supply to Willow Way will be relied upon by Willow Way to provide you with the services and for statistical and research purposes. You undertake not to use, in any circumstances, the trademarks, logos, designs, trade names, the copyright, know-how and patents relating to Willow Way. If you do use any of these intellectual property rights, you will be liable for any damages that may be suffered, and you may also be liable to criminal prosecution. You indemnify Willow Way for every single consequence flowing from the unauthorized use of these intellectual property rights. 3. BREACH: If you fail to observe or perform any of the Terms and Conditions of this agreement, then Willow Way shall be entitled, if it decides to do so, to immediately suspend your entitlement to membership to Willow Way until such time as the breach has been remedied to the satisfaction of Willow Way , or to terminate this agreement immediately. Whichever remedy Willow Way may select, it may still claim damages against you and exercise any rights against you which it has in law. Willow Way has no obligation to notify you in advance of the remedy which it may choose. 4. CESSION AND DELEGATION: You may not cede any of your rights or delegate any of your obligations under this agreement to any person or entity without Willow Way’s consent. Willow Way shall be entitled to cede, assign or delegate any of its rights and obligations under this agreement to any person or entity without your consent. 5. TERMINATION: Termination of your any membership will require thirty (30) days’ notice period. 6 and 12 months contracts must be honoured and the full amount outstanding will be paid upon termination. Cancellations must be sent to [email protected] If you wish to freeze your membership a once off reactivation fee of R1000 will be charged on top of your membership fee. Membership freeze maximum one month per year. 6. DOMICILIUM: You choose domicilium citandi et executandi for all purposes under this agreement: ADDRESS All notices in terms of this agreement shall be in writing. If a notice is delivered by hand, it will be deemed to have been received at the time of delivery. If a notice is transmitted by facsimile or e-mail, it shall be deemed to have been received on the first business day following transmission. 7. GENERAL: You consent to the jurisdiction of the Pretoria High Court in South Africa in respect of any proceedings that may be bought by Willow Way against you arising out of this agreement. Either party may elect to refer any dispute to arbitration, to which the other party consents. This agreement constitutes the entire agreement between Willow Way and you relating to your membership. Any changes to this agreement must be in writing and may take the form of notifications by Willow Way to you. If one or more of these terms are found to be unenforceable, that term shall be deemed to be severable from the remainder of these terms and the remaining terms of this agreement shall in all other respects remain in full force and effect. There are risks associated with exercising and using gym equipment which can result in serious injury and even death. You accept responsibility for such risks. We recommend that you seek medical advice before you start a new exercise regime and that you always exercise to a level that is appropriate, given your knowledge of your 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 me. I accept it is my responsibility to ensure that I am medically fit to exercise and I will seek medical advice if I am unsure of my medical condition. I understand and agree to the following disclaimer: To the fullest extent permitted by law, Willow Way, or any of their direct or indirect affiliates who may give you access to their facilities as a result of this Contract, and/or their directors, employees and independent contractors. (collectively, ' Willow Way ') 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 (other than a grossly negligent) act or omission of Willow Way, other members or guests.