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6 MONTH TRIBE MEMBERSHIP - $59 / MONTH
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CUSTOMER INFORMATION
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FACEBOOK NAME
*
Email
*
EMERGENCY CONTACT INFORMATION
Emergency Contact Information: Name
*
First
Last
Phone
*
Relationship
*
PAYMENT PLAN AND PACKAGE OPTIONS
Add supplements to your purchase?
*
No
Yes
Protein Powder
Chocolate Peanut Butter - $49.00
Chocolate - $49.00
Cookies and Cream - $49.00
Vanilla - $49.00
All other supplements
Sculpted (green pills) - fat / water retention reducer - $35.00
LipoSculpt (red pills) - enhanced energy booster - $40.00
NightSculpt (blue pills) - sleep aid - $40.00
CortiSculpt (purple pills) - stress relief - $40.00
Pre-workout (fruit punch powder) - energy booster - $45.00
BCAA (grape powder) - muscle recovery / protein synthesis - $30.00
VitaSculpt (yellow pill) - multivitamins - $25.00
CarbBlocker (red/black pill) - reduces carbohydrate absorption - $30.00
Chocolate Protein quantity
*
1 Bottle - $ 49.00
1 Bottle - $ 49.00
2 Bottles - $ 98.00
3 Bottles - $ 147.00
Chocolate Peanut Butter Protein quantity
*
1 Bottle - $ 49.00
1 Bottle - $ 49.00
2 Bottles - $ 98.00
3 Bottles - $ 147.00
Cookies and Cream Protein quantity
*
1 Bottle - $ 49.00
1 Bottle - $ 49.00
2 Bottles - $ 98.00
3 Bottles - $ 147.00
Vanilla Protein quantity
*
1 Bottle - $ 49.00
1 Bottle - $ 49.00
2 Bottles - $ 98.00
3 Bottles - $ 147.00
Sculpted (green pills) quantity
*
1 Bottle - $ 35.00
1 Bottle - $ 35.00
2 Bottles - $ 35.00
3 Bottles - $ 105.00
LipoSculpt (red pills) quantity
*
1 Bottle - $ 40.00
1 Bottle - $ 40.00
2 Bottles - $ 80.00
3 Bottles - $ 120.00
NightSculpt (blue pills) quantity
*
1 Bottle - $ 40.00
1 Bottle - $ 40.00
2 Bottles - $ 80.00
3 Bottles - $ 120.00
CortiScuplt (purple pills) quantity
*
1 Bottle - $ 40.00
1 Bottle - $ 40.00
2 Bottles - $ 80.00
3 Bottles - $ 120.00
Pre-workout (fruit punch powder) quantity
*
1 Bottle - $ 45.00
1 Bottle - $ 45.00
2 Bottles - $ 90.00
3 Bottles - $ 135.00
BCAA (grape powder) quantity
*
1 Bottle - $ 30.00
1 Bottle - $ 30.00
2 Bottles - $ 60.00
3 Bottles - $ 90.00
VitaSculpt (yellow pills) quantity
*
1 Bottle - $ 25.00
1 Bottle - $ 25.00
2 Bottles - $ 50.00
3 Bottles - $ 75.00
CarbBlocker (red/black pills) quantity
*
1 Bottle - $ 30.00
1 Bottle - $ 30.00
2 Bottles - $ 60.00
3 Bottles - $ 90.00
Total
Membership
$ 0.00
Membership + Supplements
$ 0.00
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MEMBERSHIP AGREEMENTS
6 Month Tribe Membership Agreement
*
I have read and agree to the Terms
Terms of Service
TRIBE MEMBER AGREEMENT AND COMMITMENT
1. You must text toes on scale weight on Sundays and or weigh in at the camp on Monday.
2. Photos and videos are regularly taken during workout sessions to be used to inspire others and encourage a healthy lifestyle. All photos and videos are displayed on social media outlets to motivate others to work hard to achieve their goals. As such, all members agree to allow their pictures and videos to be posted to social media outlets.
3. The meal plan that you will receive belongs to Travis Garza and TLC Fitness. It is NOT to be shared with anyone. If we discover that you have distributed or shared the meal plan, you will be removed from the Membership and will NOT receive a refund.
4. We believe our clients are my best advertisement. We strive to do everything in our power to push our clients to be their best. By initialing, you agree to let us push and motivate you the best way we know how.
5. Cancellation must be in writing. Cancellation will not go into effect until after 30 days of written cancellation.
Liability Agreement
*
I have read and agree to the Terms
I agree to hold harmless Travis Garza/TLC Fitness, Inc., and all of his employees or agents free from any and all injuries, losses, damages, and liability occurring from my participation in the activity for which I have enrolled. I also agree to be photographed/videotaped and release the use of the photographs/videos for publicity in “Indiana ‘Fat Loss Camps’ and TLC Fitness, Inc.’s publications and other marketing tools.
Payment Authorization
I (type name below)
*
hereby authorize “Indiana Fat Loss Camp” to charge my credit card or debit card any and all payments as indicated below. I further authorize my credit card company or bank to make payment to” Indiana Fat Loss Camp” by the method indicated below and to post it on my account.
Total
*
$ 0.00
Credit / Debit Card
*
Card
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