Membership Freeze

Membership Freeze

Personal or Medical
Please fill out the below form to request a Membership Freeze.
(Personal or Medical)

Terms & conditions apply.
Name

First NameLast Name
Email
example@example.com
Membership Number
Please choose Membership Freeze type
Personal Freeze - Terms

Full month increments up to 6 months.
$10 per month instead of your regular monthly membership dues.
Freeze Start Month
Freeze End Month
Medical Freeze - Terms

Full month increments up to 6 months. One-time $25 administrative fee, then $0 per month. Requires a doctor's note.
Freeze Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Freeze End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Please upload a copy of your doctor's note or bring into membership services

Cancelof
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: