Get Fitness Facility Member Verification Form

Completing the Fitness Facility Member Verification Form online is a straightforward process that ensures your eligibility for the ExerciseRewards program. This guide will walk you through each section of the form, allowing you to submit it with confidence.

Follow the steps to complete your form effectively.

1. Click ‘Get Form’ button to access the Fitness Facility Member Verification Form and open it for editing.
2. Fill in your full name at the designated section, including your last name, first name, and middle initial.
3. Enter your date of birth and Health Plan ID in the corresponding fields.
4. Complete the fitness facility information section by providing the facility name, address, city, county, state, and ZIP+4 code.
5. Select the type of arrangement by checking the appropriate box: Fitness Facility Agreement, Signed Application, Individual Class at a Facility, or Other.
6. If you have a family membership, list the names of family members in the provided space.
7. Enter the amount paid for your membership and indicate if it is month-to-month or annual, along with the relevant start and end dates.
8. For individual classes, provide the number of classes and the dates of the first and last class.
9. Obtain the fitness facility representative's confirmation by filling in their name and signature in the fitness facility attestation section.
10. Finalize the form by saving your changes, downloading, printing, or sharing it as needed before submission.

Complete your Fitness Facility Member Verification Form online today to ensure your ExerciseRewards eligibility.