LA Fitness: Student Voucher Request Form
Please complete this form if you wish to purchase an LA Fitness Paid-In-Full/Annual/Prepaid membership. If you want to purchase an month-to-month membership you will need to do that via the YouPortal.
Name
*
First
Last
Your College:
*
Select One
College of Dental Medicine
College of Graduate Nursing
College of Health Sciences
College of Health Sciences - Northwest
College of Optometry
College of Osteopathic Medicine
College of Osteopathic Medicine - Northwest
College of Pharmacy
College of Podiatric Medicine
College of Veterinary Medicine
Graduate College of Biomedical Sciences
WesternU E-mail Address
*
Annual Prepaid Membership You Want to Purchase
*
Select one
Premier Single-State (includes racquetball) $299/year
Signature (includes racquetball) $359/year
Please read and acknowledge
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I may be eligible for the up-to $100 reimbursement from WesternU if I purchase the membership by September 1, 2023, and submit my request to University Student Affairs no later than September 1, 2023.
I understand and will submit my reimbursement request by the deadline.
Do you also want to purchase a membership for a family member?
*
Up to three family members living in the same household can purchase a membership at the same price.
No thank you
Yes, one family membership
Yes, two family memberships
Yes, three family memberships
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