Are you an Existing Client?*

YES, Remember Me?
NO, Looking Forward to it.

PureGlo Membership*

First Name*

Last Name*

Phone Number*

Email*

Is this Monthly Membership a Gift?*

YES
NO

If Yes, What is the name of the recipient?

I agree to enroll in the PureGlo Facial Membership for a minimum 3 month period.*

YES

I understand and agree with the following terms and conditions of the PureGlo Facial membership:*

1. Memberships are a minimum 3 month commitment, paid monthly—subject to the monthly membership agreement, and applicable sales taxes.
2. Your credit card will be charged upon sign-up, and then auto-charged on the 1st of every month. Each month you’ll receive one facial benefit, based on the tier of your membership.
3. Your membership will continue month to month, unless cancelled via email.
4. The membership entitles you to choose from a menu of facial treatments that has been provided at the time of this agreement and is always available online at pureglo.ca/memberships.
5. Failure to provide 24-hour notice of appointment cancellation will forfeit that service for that month.
6. The membership monthly fee is specified above. As long as I am enrolled in this membership, this fee will be charged automatically to my credit card on the first day of each month.
7. Any unused/missed months will still be billed each cycle without exception as there are no roll over or pause options at this time.
8. Memberships are non-transferable, exchangeable or refundable and cannot be combined with other offers or promotions.
9. I understand there is a 30-day cancellation period, and will be charged for 1 more month of membership before my cancellation goes into effect.
10. I understand that, in order to successfully cancel this automatic charge, my 30 day notice of cancellation to PureGlo must be in writing via email or letter.

I, AGREE

I hereby authorize PureGlo to charge my Visa / MasterCard / AMEX each month in the amount specified above for the membership I have selected.*

I, AGREE

NOTE: Once we receive your subscription activation, one of our team members will reach out to schedule your first facial + professional skin analysis.

Notes to Clinic

Thank You!

Your Preferred Medical Aesthetics Clinic in London, ON

Your Preferred Medical Aesthetics Clinic in London, ON