In addition to the payroll deduct authorization form below, you will also need to submit the membership registration form, found here, to complete your membership to the Fitness Center.Payroll Deduct Authorization (check one only)* Begin Payroll Deduction Stop Payroll DeductionEmployee ID Number*Employee Name*Employee Badge Number (located on back of badge)*Please Check Company* Vizient Apexus/Aptitude ProvistaAfter Tax Deduction Amount = $12.50 per pay periodStart Date*Cancellation Date*Employee Authorization* I hereby authorized Vizient to initiate the above payroll deduction action regarding my membership dues. I acknowledge that this payroll deduction action will be effective on the pay period with a begin date closest to my join date and that deductions will occur each pay period thereafter. I understand that this payroll deduction action, once commenced, will continue until I provide a minimum of 30 days notice to the Fairways Fitness center in writing or via this form. I understand that no refunds, whole or partial, for membership dues will be given under any circumstances other than Vizient payroll processing error.
