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Full Name *

Phone Number *

Street Address *

City *

Zip Code *

Email Address *

Date of Birth *

CrossFit Plan *

Unlimited Adult CrossFit $125.00/month

3 day per Week $105.00/month

Unlimited Military/1st Responder $105.00/month

Unlimited Family 2 Parents and Children 13-21 years $300.00/month

Please provide us with your billing information. Membership billing will begin on your first day of class.

Name on Card *

Card Number *

Expiration Date *

Address (if different from above)

I authorize CrossFit Playground (Break Ground Fitness) to bill my credit card for the appropriate service selected above.

By checking this box you agree that CFPG will bill your card.

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