GOODLIFE FITNESS APPLICATION FORM

As a GM CAMI ASSEMBLY employee, you and your spouse/significant other are eligible to obtain GoodLife memberships at approximately 45%-50% off the regular rates! GoodLife currently has over 275 locations in Canada (www.goodlifefitness.com), state of the art equipment, as well as helpful, qualified staff. Memberships are offered through a one time upfront payment. This special offer is available to you by simply completing this Application form and submitting it to Liliana Dinich [email protected] – 519 425-3152 ext. 4714

The anniversary date is June 15th each year. We require a minimum employee participation level to continue to offer this preferred rate – please submit this form by the 7th of the month. You will have an opportunity to join the program on the 15th of any month. Your Family Member is eligible to join only if you are also participating. You will find the pro-rated amounts for additional sign-up periods below.

Family Member is defined as husband, Wife, Girlfriend, Boyfriend, Same Sex Partner, or Dependent Children (in accordance with GoodLife’s minimum age policy) living under the same roof.

If you have an existing GoodLife membership purchased at a GoodLife club (not through this corporate program) and you wish to cancel your membership, please request a cancellation form from your local HPM office.

New Enrollment and Renewal (June 15th 2017 through June 14th 2018) **If renewing, please make sure to include your current membership number (very important)**

Name of CAMI ASSEMBLY Ingersoll Employee: ______CAMI ID ______

Date of Birth(MM/DD/YYYY): ______Phone #: (____)______Email: ______

Mailing Address: ______Street – city – province – postal code

REGISTRATION SCHEDULE  I wish to Enroll in the GoodLife Membership program.  I wish to Enroll my Family Member: Name: ______ I wish to Enroll my Family Member: Name: ______ I wish to Renew my current GoodLife Membership: Membership # 10538______ I wish to Renew my Family Member' current GoodLife Membership: Membership #10538______PLEASE CHECK YOUR DESIRED START DATE  June 15th start date.  July 15th start date.  August 15th start date. $451.00 each membership $414.00 each membership $376.00 each membership

 September 15th start date.  October 15th start date.  November 15th start date. $339.00 each membership $301.00 each membership $263.00 each membership

 December 15th start date.  January 15th start date.  February 15th start date. $226.00 each membership $188.00 each membership $150.00 each membership

 March 15th start date.  April 15th start date.  May 15th start date. $113.00 each membership $76.00 each membership $38.00 each membership

*All rates include Taxes.

Submit this form to Liliana Dinich (Inbox in the GMS Office Located next to the Paint Shop Office) along with a cheque payable to…CAMI Goodlife Signup.

IMPORTANT NOTES:

 Must be a current CAMI Assembly Ingersoll employee to join.  This is a benefit for CAMI Assembly Ingersoll employees and their Family Members living under the same roof only.  ($28.25 charge for replacement cards)  NO REFUNDS PERMITTED. Memberships cannot be put on hold for any reason.

______Employee’s Signature Date