Join Indica Spa Form

Join Indica Spa Club for an annual fee of only $59!

»	Entry in Monthly Draw to win an Indica Spa & Wellness Treatment	»	10% discount on all treatments* (with the exception of Waxing & HiCapfunded treatments)
»	Priority Bookings	»	Exclusive Special Offers
»	Email Newsletters	»	2 x $20 vouchers (1 for you & one for a friend)

* Required

Title

First Name *

Last Name *

Email Address *

Billing Address *

City *

State *

Zipcode/Postcode *

Country *

Cell Phone Number *

Mobile Phone Number

Daytime Phone Number

Name on Card *

Card Number *

Card Expiry *

Card Type *

CCV Number *

Amount *

Enter Word Verification in box below *

X Join Indica Spa Club for an annual fee of only $59!

»	Entry in Monthly Draw to win an Indica Spa & Wellness Treatment	»	10% discount on all treatments* (with the exception of Waxing & HiCap funded treatments)
»	Priority Bookings	»	Exclusive Special Offers
»	2 x $20 vouchers (1 for you & one for a friend)	»	Email Newsletters

Yes please, I would love to be an Indica Spa Club member for an annual payment of $59.

NOTE: This form will be submitted through our secure online server which is PCI compliant







	Enter Word Verification in box below *
	Total: $59

X Gift Voucher
Please let us know what type of gift voucher or dollar amount, we will contact you to confirm

NOTE: This form will be submitted through our secure online server which is PCI compliant






I would like the following services:	Card Details



Amount * $50 $100
Other	Enter Word Verification in box below *

Total: $59