MEMBERSHIP program

Welcome to the VIP Experience

We are pleased to offer you exclusive access to our VIP Membership Program, where your commitment to self-care meets premium rewards, savings, and personalized attention. This program is for our most loyal clients!

Monthly Benefits

One complimentary B12 injection
10% off all Injectables (Botox, Dermal Fillers, etc.)
10% off Laser Services
10% off Skincare Products

Quarterly Benefits

Enjoy one complimentary signature service, your choice of:

Hydrafacial
Microneedling
Photofacial
Chemical Peel
Microdermabrasion

Annual VIP Perks

Free Birthday Gift (up to $50 value)
$200 Off Cosmetic Surgery
Priority Scheduling for Appointments
Exclusive Access to VIP Member Events

Membership Registration

Submit your registration, and we’ll call to finalize your membership and process your payment.

First Name

Last Name

Birthday

Month

Day

Year

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

MEMBERSHIP AGREEMENT & TERMS

I acknowledge and authorize to pay the one-time, non-refundable $69 enrollment fee.

I authorize monthly billing and agree to keep a credit card on file. I understand my card will be charged automatically each month and stored securely. Membership will auto-renew monthly unless canceled in writing after the 6-month minimum commitment.

I agree to the $99 early cancellation fee if membership is canceled before completing the 6-month minimum commitment.

DISCLAIMERS & ILLINOIS STATE REQUIREMENTS

All medical procedures and services will be provided only after consultation and deemed appropriate by a licensed provider.
Membership benefits may not be combined with other promotions or discounts unless otherwise noted.
Memberships are non-transferable and non-refundable.
All services are subject to provider availability and patient candidacy.
Illinois law requires all treatments be performed or supervised by licensed professionals in accordance with IDFPR regulations.
Patient privacy and protected health information (PHI) will be managed in compliance with HIPAA and Illinois Medical Practice Act standards.
Burt & Will Plastic Surgery l Dermatology and Limelight MedSpa reserve the right to modify membership terms, pricing, or services with 30 days' notice.

CONSENT TO RECEIVE MARKETING COMMUNICATIONS: By checking below, I agree to receive informational and promotional emails and text messages from Burt & Will Plastic Surgery l Dermatology, Limelight MedSpa, its affiliates, and authorized partners regarding special offers, events, and updates. I understand that I can opt out at any time by calling 815-267-0231.

ELECTRONIC SIGNATURE: By electronically signing below, I confirm that I am at least 18 years of age and possess the legal capacity to enter into this agreement. I understand that my electronic signature holds the same legal validity and enforceability as a traditional handwritten signature. By signing electronically, I consent to conduct business electronically with Burt & Will Plastic Surgery | Dermatology and Limelight MedSpa. This includes, but is not limited to, agreeing to the membership terms, conditions, and disclaimers; receiving electronic records and communications; and authorizing transactions. I acknowledge that I have read, understood, and agree to be bound by the terms, conditions, and disclaimers of Burt & Will Plastic Surgery | Dermatology and Limelight MedSpa. I understand these terms govern the provision of services and outline any associated responsibilities or obligations. I affirm that my electronic signature is legally binding and enforceable, and I waive any objection to the validity or enforceability of this document based on its electronic form.

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