Monoliza Membership Form

Join the Family

Complete the form below to register and pay for your Monoliza membership. All required fields are marked with *.

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Section 1

Personal Details

All fields are required unless noted.

First Name*

Last Name*

Date of Birth*

Phone Number*

Email*

Home Address*

City / Town*

State / Region / Province*

Zip / Post Code

Country*

Portrait photo *

A clear front-facing photo for member identification. JPG/PNG, max 4MB.

No photo

Section 2

Company Details

Optional — leave blank if not applicable.

Company Name

Position

Company Address

Company City / Town

Company State / Region

Company Zip / Post Code

Company Country

Section 3

Membership Selection

Choose the membership type and duration that suits you.

Membership Type*

Duration*

Selected Plan

Standard — 3 months

Total (incl. taxes)

₦202,500

Includes VAT (7.5%) and Entertainment Tax (5%).

Section 4

Communication Preferences

Choose as many as you like (optional).

WhatsApp CommunityEmail

Section 5

Health & Medical Information

All fields optional but recommended for your safety.

Do you have any pre-existing medical conditions?

Do you have any physical limitations that may affect your ability to participate in physical activities?

Are you currently taking any medications?

Do you have any allergies?

How would you describe your current lifestyle?

On average, how many hours per week do you engage in physical activity?

What type of physical activity do you prefer? (select all that apply)

Cardiovascular exercises (running, cycling, swimming)Strength training (weightlifting, bodyweight)Flexibility & balance (yoga, pilates, stretching)Sports & recreational (basketball, soccer, hiking)

Anything else you'd like us to know about your health or activity level?

Section 6

Emergency Contact

Who should we contact in case of an emergency?

Name*

Phone*

Relationship

Section 7

Referral

Were you referred by a Monoliza staff member?

Staff Referral Name

You're paying

Standard · 3 months

₦202,500

You'll be redirected to Paystack to complete payment securely. Your membership becomes active once payment is confirmed.

Plan Tier	3 Months	6 Months	Annual