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Membership Benefits
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»
Personal Membership -
up to 25% OFF regular prices!
The personal membership program allows the individual to enjoy the luxury of a special directory of spa services at great savings.
only $129* per year |
more details...
*GST not included, All prices are listed in Canadian funds
Registration - Get Your Discount Card Now
Membership Application
FAMILY Membership Application
CORPORATE GOLD Membership Application
CORPORATE PLATINUM Membership Application
Fields marked with an asterisk (*) are required
First Name:
*
Last Name:
*
Address1:
*
Address2:
City:
*
Province:
*
Postal Code:
*
Phone #1:
*
Phone #2:
Email:
*
Gender:
Male
Female
Birthday:
day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
mth
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Family Name:
*
PRINCIPLE CONTACT
First Name:
*
Last Name:
*
Address1:
*
Address2:
City:
*
Province:
*
Postal Code:
*
Home Phone:
*
Work Phone:
Fax Number:
Email:
*
Company Name:
*
Address1:
*
Address2:
City:
*
Province:
*
Postal Code:
*
Work Phone #1:
*
Work Phone #2:
Fax Number:
Email:
*
Additional Members
Please list all authorized individuals of your family (or other) that are entitled to the privileges of your Family Membership. Please note: Photo ID will be required to verify these individuals, prior to treatment or service. Names may be added or removed, at any time, only by the Principle Contact (above).
Note: Include member last name if different than family name.
Name:
Phone:
Name:
Phone:
[Add more members]
Name:
Phone:
[Add more members]
Name:
Phone:
[Add more members]
Name:
Phone:
Principle Contact(s)
The individual(s) listed below will be responsible for booking, confirming and cancelling appointments made under your Company profile.
CONTACT #1
First Name:
*
Last Name:
*
Title:
Mr.
Ms.
Mrs.
Miss
Dr.
Work Phone #1:
*
Email:
*
CONTACT #2
First Name:
*
Last Name:
*
Title:
Mr.
Ms.
Mrs.
Miss
Dr.
Work Phone #2:
*
Email:
*
Delivery Information
(if different than above):
First Name:
Last Name:
Address1:
Address2:
City:
Province:
Postal Code:
Membership Password
Create a membership password:
(4 – 8 Alpha / Numeric characters
)
Password:
*
Verify Password:
*
This password is confidential and intended to verify and identify the Principle Contact as listed above. To maintain the integrity of your membership, please do not share this information with others. If you should forget your password, or any of the information above has changed please contact Spa Utopia directly. A series of questions will be asked prior to making any changes to your account information.
Primary Location
I/we intend to primarily use the membership in:
Location:
choose one...
Langley
North Vancouver
Pan Pacific
*
Shipment
Pick Up
Regular Mail
Delivery (2 Days, $15 charge)
If pick up, your card will be available from your primary location above.
Payment Amount
Amount:
$
GST:
$
Total:
$
Declaration
I have read and understand the
Terms and Conditions
of the Membership
After you click the Submit Order button below, please allow a few seconds for your order to be processed. You will see our "Thank You" page after your order is successfully received.
©2005 Spa Utopia™
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