Benefits Program Enrollment Form Name(Required) First Last Phone(Required)Date MM slash DD slash YYYY Email(Required) Membership Type(Required) 60-Minute Benefits Program 90-Minute Benefits Program By signing below, I acknowledge I have read and understand the information on this form in its entirety. I am authorizing LaVida Massage and its merchant account processor to process credit card transactions from my account. This authority will remain in effect until I provide a written notice to cancel the Benefits Program. The session credits from my membership will not expire as long as my membership remains active. These credits are nonrefundable. A 30-day notice is required to cancel the program. I will then have 90 days to use any remaining accumulated session credits, after which all accumulated sessions will be forfeited from my account and will not be reinstated. I understand that I am paying for a membership at LaVida Massage, and to receive benefits from my membership it requires my active participation. Membership session credits may only be used at this LaVida Massage location. Not valid with any other offer. Appointments must be canceled no later than the day before the appointment to avoid a charge up to the cost of the scheduled service. Terms and conditions are subject to change.Signature