Summer 2011 Program Registration

GROUP 1:
June 14 - August 18, 2011
Tues/Thurs Mornings
5:45 am - 7:00 am

GROUP 2:
June 15 - August 19, 2011
Wed/Fri Mornings
5:45 am - 7:00 am
*except Friday, July 1st holiday

Early Bird (on or before May 23)	$160	Sign up 2 together for $290
After May 23	$175	Sign up 2 together for $325
10 Visit Drop-In	$100	limited number available

Refund policy: A $20.00 administrative fee will be subtracted from all refunds given.

Name:

Phone No.:

Email Address:

Emergency Contact Name:

Emergency Contact Phone No.:

Which would you like to sign up for?

Group 1: June 14 - Aug 18 (Single)
Group 1: June 14 - Aug 18 (Double)
Group 2: June 15 - Aug 19 (Single)
Group 2: June 15 - Aug 19 (Double)
10 Drop-in

NOTE: If you are registering for two people, please fill out the second person's information below.

Second Person's Name:

Second Person's Phone No.:

Second Person's Email Address:

PLEASE READ WAIVER CAREFULLY:

I, on behalf of myself, members of my family, my heirs, executors, administrators and assigns, hereby forever release, discharge and hold harmless The Fast Lane Fitness Company owners, representatives and agents for injury, loss or damage to my person or property howsoever caused, arising out of or in connection with my taking part in Fast Lane Fitness organized events and activities and, notwithstanding, that the same may have contributed to or occasioned by the negligence of The Fast Lane Fitness Company owners, representatives or agents.

I agree: *

PAY ONLINE:
To register and pay online, click here. After you click submit, you will be redirected to PayPal - either sign in or click Continue on that screen if you do not have a PayPal account. You do not need to have a PayPal account to register and pay online for Fastlane.

PAY IN PERSON:
To register and pay by cash or cheque, download the form .

PAY AT SPEED THEORY:
2616 West 4th Avenue