Membership Program Consent Form Membership Program Consent Form I understand that I am signing this consent form to become a member with Refresh Evolution. I understand that by signing this consent form I am committing to 12 equal monthly payments which are to be deducted from my stored credit card and that should this card expire I will update refresh evolution with immediate effect at info@refreshevol.wpengine.com . I understand that my membership will include the following benefits: 1 or 2 free Laser Hair Removal Treatments depending which membership I purchase. The Gold Membership will include one small area out of the following: Underarms, Bikini, Treasure Trail, Toes, Fingers, Upper Lip, Chin, Sideburns The Platinum Membership will include 2 of the following areas: Underarms, Brazilian, Bikini, Treasure Trail, Fingers, Toes, Upper Lip, Chin Sideburns, Hands, Feet, Knees With my Membership I understand I will also receive discounts on the following: Dermal Filler, Botox, Products, Services PLUS a Free Dermaplaning and/or Chemical Peel on my Birthday depending which Membership I purchase. Should I want to cancel early I understand I will be obligated to add the discounted amount on to each treatment that has been completed to date of cancelation. I have read the above and fully understand the details regarding my Membership. * I have read and agree to the terms. Name* First Last Date* Date Format: MM slash DD slash YYYY LocationLocationPitt MeadowsPort MoodyELECTRONIC CONSENTAGREEDISAGREEELECTRONIC CONSENT: Please select your choice below. Clicking on the "agree" button below indicates that: • I have read and fully understand this agreement and all information detailed aboveSignature*SkillsInterests
