Membership Checkout – Stage Site Fit

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Membership Level change

You have selected the Back2Basics Fitness Challenge membership level.

The price for membership is $59.00 now.

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Username

Password

Confirm Password

Email Address

Confirm Email Address

Full Name LEAVE THIS BLANK

First Name

Last Name

Address 1

Address 2

City

State

Postal Code

Country

Phone

Card Number

Expiration Date /

Security Code (CVC)

Discount Code

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