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Information is securely collected and a copy of the form will be forwarded to the email you provided at time of processing. If you have any questions about the membership form, please reach out to Jason Sullins at evolutionmmachicago@gmail.com.

Evolution MMA Sign Up and Waiver

Buyers Name

Membership Agreement - The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants with respect to any aspect of a credit transaction on the basis of race, color, religion, national origin, sex or marital status, or age (provided the applicant has the capacity to contract). The agency that administers compliance with this law is the Federal Trade Commission, Equal Credit Opportunity, and Washington, D.C. 20580. BUYER INFORMATION ONLY - TO BE FILLED OUT BY APPLICANT

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email Address

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PAYMENT INFORMATION

Sign-up Date

Date you would like your membership to begin.

YYYY

Payment Authorization

Monthly membership is $120 per month. A one time membership fee of $70 will be charged with your first payment, for a total price of $190 for your first month. I authorize my bank to make my payment by the method indicated below and post it to my account.

I AGREE, I authorize my bank to make my payment by the method indicated below and post it to my account.

Credit/Debit Card

Visa

MasterCard

American Express

Discover

Account #

Expiration Date

YYYY

CVV Code

Buyers Signature

Cancellation Policy: You the buyer may cancel this Contract by midnight of the third business day after the date of this Contract. In order to cancel, you must notify the Seller in writing. Return this Contract by (a) certified mail, return receipt requested, to Evolution Team Mixed Martial Arts LLC 1207 Remington Rd, Schaumburg IL 60173 Unit 105. IMPORTANT: We require 30 days written notice for cancellation, or you will be billed again. Notice to the Buyer: (1) Do not sign this Contract before you read it or if it contains any blank spaces. (2) You are entitled to a completed copy of this Contract. A copy will be forwarded to you upon processing (may take 24-48 hours). (3) Buyer acknowledges that Buyer has read this Contract with disclosures made in compliance with federal and state law, and authorizes Seller to verify any information relating to Buyer's credit and financial responsibility that it deems necessary and to verify this sale by contacting Buyer at the phone number(s) listed on form above. Type your name below to authorize Evolution MMA to bill your credit card on sign-up date indicated by you in form above.

WAIVER

Participation Waiver

In consideration of being permitted to utilize the facilities, services and programs of Evolution MMA Team and Alliance Jiu-Jitsu Team including, but not limited to, observations or use of facilities and equipment and participation in any program, I, on behalf of myself, or applicable children, dependents or personal representatives, hereby: 1: Acknowledge that I have (a) read this release and waiver of liability; (b) had the opportunity to inspect the school’s facilities and equipment or will immediately upon entering or participating, inspect and carefully consider such premises, facilities and programs; (c) accept the facilities, equipment and program as being safe and reasonably suited for the purpose intended and (d) voluntarily sign this release and waiver of liability. 2: Release the school, its directors, officers, employees, agents and volunteers (collectively “School Releasees) from all liability to me for any loss of damage to property or injury or death to person, whther caused by the orinary negligence of the School Releasees or any other person, and while I am in, upon or about any school equipment therein or participating in any program or service affiliated with the school. 3: Agree not to sue the School Releasees for any loss, liability, damage, injury or death described above and I agree to indemnify and hold harmless the School Releasees and each of them from any loss, damage or cost they may include due to my presence in, upon or about the School facilities or equipment therein or from my participating in any program or service affiliated with the School whether caused by the ordinary negligence or the School Releasees or by any other person. I assume full responsibility for the risk of such loss, liability, damage, injury or death. I intend for this release and waiver of liability to be as broad and inclusive as is permitted by the laws of the state of Illinois. If any portion hereof is held invalid, I agree that the balance shall continue in full force and effect. I hereby state that I am joining Evolution MMA and Alliance Jiu-Jitsu Team of my own volition and that I have not been pressured to join in any way whatsoever. Signature

Parent/Guardian Name (under 18 applicant)

Emergency Contact Information

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train with us

Unlimited Training in all classes for $120 per month

With your first week Free to try out if you sign up today

sign up for a monthly membership at evolution mma.

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EVOLUTION MMA - SCHAUMBURG

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