Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Termination *

30 day written notice is required to cancel a monthly membership plan, and as such, the next month will be charged. No refunds will be issued after monthly membership dues have been charged or paid in full.

By checking this box you agree to the terms listed above

Auto-Renewal *

Your membership will automatically continue past the minimum initial required period of 12 months until you submit a written request to terminate your membership as above.

By checking this box you agree to the terms listed above

Early Termination *

If you choose to terminate your membership prior to the end of the initial 12 month period (or stop auto-payments), there will be a minimum $500 Early Cancellation Fee which will be paid with any funds in the Spa Bank and if there is a remaining balance due, it will be charged to my credit card on file. Requests for early termination must be submitted in writing as above. Early termination is not final until/unless approved by the Owner/Administrator. Additionally, if early termination is approved, members are no longer eligible for free monthly services or the 10% discount on products or services. Again, 30 day written notice before your next scheduled payment is required to cancel a monthly membership plan, and as such, the next month will be charged.

By checking this box you agree to the terms listed above

Refunds *

I also understand that no refunds (or Spa Bank credits) will be issued for membership fees or late fees.

By checking this box you agree to the terms listed above

Release and Waiver of Liability *

I have read and understand this waiver and have been fully informed of all of aNu Aesthetics and Optimal Wellness membership terms and conditions as well as membership benefits and limitations. I certify that I have disclosed all medical conditions that might affect my treatments. I understand that providers cannot diagnose any medical conditions and I release them from any injury resulting from undiagnosed medical conditions present during my treatment. I assume all responsibility for updating changes in my medical condition and for reporting all injuries sustained at aNu Aesthetics and Optimal Wellness at the time of service.

By checking this box you agree to the terms listed above

Notice to Members *

The Member is entitled to a completed copy of this agreement. The Member acknowledges that this document is an Agreement and is legally binding upon your signature. The Member also understands there will be no refunds issued for any charged dues. The undersigned Member acknowledges receipt of aNu Aesthetics and Optimal Wellness’ membership terms and conditions and has read, understands and agrees to be bound by the terms and conditions as part of this agreement.

By checking this box you agree to the terms listed above

Monthly Membership Dues *

Membership dues will be automatically charged to the Member's credit/debit card on the 1st business day of every month.

By checking this box you agree to the terms listed above

Authorization *

I authorize aNu Aesthetics and Optimal Wellness to charge my monthly membership fee to my financial institution via Electronic Funds Transfer with the credit/debit information I have provided. I understand that I am in full control of my payment, and if at any time I decide to make any changes to my credit/debit card information, I must notify aNu Aesthetics and Optimal Wellness within 7 business days. Changes of payment method will not affect other provisions and terms of my agreement.