Request Admittance

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-By approval-

- BY APPROVAL -

REQUEST ADMITTANCE

Membership Application

Please Fill out this Form to Apply for Membership.

Full Name*

Date of birth

Month

Day

Year

Email address*

Phone number*

Preferred Method of Contact*

Membership Selection*

What is the MOST Important to You?

Consistency

Cost

Treatment/Care

Schedule Flexibility

Luxury Experience

How Often Do You Typically Receive Massage Services?

Weekly

Biweekly

Monthly

Occasionally

Additional Notes or Requests

I understand that submission of this form does not guarantee acceptance into The Havona Club membership program. Membership availability is limited and subject to approval.

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