Balance Fitness Membership Signup (Insurance)

Please use this form only if you are signing up at the gym through your insurance. We accept Silver & Fit, and OnePass (formerly known as RenewActive, Optum, and UnitedHealthCare).

Thank you for considering Balance Fitness for gym membership! We truly believe you will enjoy your time here, and we sincerely welcome you to our family. 🙂

Please use this form only if you are signing up at the gym through your insurance. We accept Silver & Fit, and OnePass (formerly known as RenewActive, Optum, and UnitedHealthCare).

Thank you for considering Balance Fitness for gym membership! We truly believe you will enjoy your time here, and we sincerely welcome you to our family. 🙂

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1Membership Options

2Billing Information

3Membership Agreement

Preferred Language for Communication: *

Insurance Program *

OnePass was also previously called RenewActive, or OptumHealth.

Silver & Fit Number (7-9 digits, all numeric) *

OnePass Number (The letter A, followed by 9 digits) *

Full Name on Health Card *

Health Plan Member ID *

Health Plan Group ID (if you have one) *

Zip Code on File with Health Insurance *

With the information above, we will do our best to locate your insurance. Please continue to fill out the rest of the form.

Your First Name *

Your Last Name *

Date of Birth *

Your Phone Number *

Your Email Address *

Street Address (Including Apartment/Unit Number, if applicable) *

City *

State *

Zip Code *

Choose Your Membership: *

Friends and Zen Package (Guest Privileges, Massage Chairs, Workout Towels, and guests also get access to Massage Chairs/Towels): $36/month
Wellness Package (Unlimited Classes, Weekly InBody Scanning, and Personal Training Guidance): $36/month
Fully Balanced Membership (All 5 add-ons, and guests get access to Massage Chairs, Workout Towels, AND one complimentary class per week): $60/month
I would like to select my own add-ons.
I would just like the basic membership.

See https://www.balancefitnessoregon.com/membershipaddons for more information on each membership add-on.

What add-on(s) would you like on the membership? *

Unlimited Classes (Learn More)
Guest Privileges (Learn More)
Reserved Locker (Learn More)
Weekly InBody Scanning (Learn More)
Massage Chairs (Includes workout towels) (Learn More)
Training Guidance (Learn More)
I would just like the basic membership.

A basic gym membership is included with your insurance (a $48/month value). Each add-on is just $24 monthly.

Prorated payment for the rest of this month, due today:

$0.00

Monthly Rate, starting the 1st of next month:

$0.00

By checking this box, I authorize Balance Fitness to automatically charge the credit card below on a recurring basis (every 1st of the month). I understand I may change the payment method anytime by visiting balancefitnessoregon.com/change. *

Agree

Billing Information *

Name on Card

Card Number

We accept Visa and Mastercard for membership.

Expiry

CVV

Billing Address

City

State

ZIP Code

No payment information required. Please make sure you notify us immediately of any insurance or plan changes.

WAIVER OF LIABILITY/ASSUMPTION OF RISK: I acknowledge that attendance at, use of, or participation in Balance Fitness facilities, activities, or equipment could be dangerous and cause injury, including death, and is undertaken at the guest's own risk. On behalf of myself and/or the minor guest I am the parent or guardian of, and my/our heirs, executors, and assigns, I fully waive, release and forever discharge Balance Fitness and their respective affiliates, parents, subsidiaries, officers, directors, employees, agents, successors, and assigns from any and all claims, damages, demands, rights of action, and causes of action, known or unknown, anticipated or unanticipated, arising out of or relating to attendance at, use of, or participation in Balance Fitness facilities, activities, equipment or provided transportation. My signature below verifies that I have read, understand, and agreed to this waiver and release of any and all liability.

Photo ID Upload

Click or drag a file to this area to upload.

Please take a photo or upload your Photo ID, Driver's License, Passport, or Student ID.

Type Full Name: *

Signature: *

I hereby certify that the signature provided above is my own.

Membership Agreement

Your contract will appear here as you fill out the form.

Acuerdo de Membresía

Your contract will appear here as you fill out the form.

The most recent membership agreement can be viewed anytime by scrolling to the bottom of any Balance Fitness website page and clicking the link.

I have read and agree to the membership agreement linked above. *

Agree