Sign up - La Elevated Wellness

Personal Details

* Required field

Visitor Member

* First name

Last name

Gender

Phone Number Add secondary Phone +

Secondary Phone

Email Address

Add secondary Email +

Secondary Email Address

Date of birth

Subscribe to SMS updates

By providing your phone number, you agree to receive SMS for marketing, account notifications and customer service from D1 Baton Rouge . Message frequency may vary. Standard Message and Data Rates may apply. Reply STOP to opt out. Reply HELP for help. Your mobile information will not be sold or shared with third parties for promotional or marketing purposes.

* Parent/Guardian's name

Pick a check-in code (4 digits)

Address

* Street address

* City

* Zip / Postal code

* State

Country

Contacts

Contact Name

Phone Number

Relation

Additional Contact

Photo

Capture from camera No camera found. Please connect a camera to use this feature. Upload or use camera Upload photo

Membership

Apply Discount

Select
Ambassador Membership

Duration 3 months

Access Unlimited

Cost FREE
Select
Monthly Coaching Membership

Duration Ongoing

Access Unlimited

Cost $99.00 / 1 month

Membership Documents

How did you hear about us?

Who referred the member to us?

More details:

Interface Language

Account Password

Please pick a password to log-in to your account later.

Password (minimum 8 characters)

Confirm Password

Payment

Select membership first

Payment Method
Bank Debit
Pay Later

Payment will be provided later.