Cosmetic Club Membership Agreement - Bryn Mawr Dermatology

RECORDS RELEASE FORM

Cosmetic Club Membership Agreement

Please enter your information and select which membership category by checking the box next to Membership Overview

Member Name

Date of Birth

Member Email

Member Phone

Please select your preferred Membership:

Membership Type

Elite Membership Essential Membership

Elite Membership Details
Monthly Membership Fee: $99
The $99 monthly membership payment is banked to the member's account for use toward eligible aesthetic services. Banked membership funds do not expire while the account remains available under practice policy and applicable law.

Membership Benefits - Elite

$99 banked each month toward eligible aesthetic services
Member pricing and/or savings on eligible aesthetic services, as designated by the practice
Member skincare savings, as designated by the practice
One complimentary qualifying facial or chemical peel annually, if included in the current membership offering
Priority access to select cosmetic events, promotions, and appointment opportunities
Exclusive member offers and package pricing throughout the year
Birthday benefit and/or other member perks as offered by the practice

Essential Membership Details
Monthly Membership Fee: $29
The Essential Membership is designed for patients focused on ongoing skincare maintenance and esthetician-based treatments. Members receive access to select treatments at designated member pricing, along with skincare and additional membership benefits as offered by the practice. This monthly payment is not banked.

Membership Benefits - Essential

Access to select esthetician treatments for $99 per session, including qualifying facials, chemical peels, dermaplaning, microdermabrasion, and Laser Genesis
Member skincare savings, as designated by the practice
Complimentary annual professional skin consultation

Member Acknowledgement and Authorization
By signing below, I acknowledge that I have read and understand the Cosmetic Club Terms of Service. I understand the six-month minimum commitment, automatic monthly billing, 30-day written cancellation requirement after the initial term, and the rules governing banked funds and membership benefits. I authorize recurring monthly charges at the rate for the membership tier I selected above, until the membership is canceled in accordance with this agreement..

Acceptance of Terms

I have read and agree to the Cosmetic Club Terms of Service

Please write your signature below

Signature Field

Date

** IMPORTANT **
Submitting this form does not complete your enrollment. A member of our team will contact you to set up your payment plan. Your membership becomes active once that is done.

Villanova, PA | Collegeville, PA
Wayne/Chesterbrook, PA

RECORDS RELEASE FORM

Your Skin is Our Business.

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Villanova

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Your Skin is Our Business.