Membership Freeze Request Form
This form is to be filled both by the Member and Personnel.
Member Name
First Name
Last Name
Member ID Number
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
When do you want it to be frozen?
-
Month
-
Day
Year
Date
Expected date of return
-
Month
-
Day
Year
Date
Reason for freezing your membership
Please upload a supporting document here
Browse Files
Drag and drop files here
Choose a file
(Doctor's Note, Financial Letter, etc.)
Cancel
of
Agreement
I understand that this request freeze needs approval. When reactivating the membership, approval is required as well.
I understand that I won't be able to enjoy the benefits of the facilities and promos while my membership is on freeze.
For medical reasons, a doctor's note is required.
While on freeze, you will not be charged for the term subscription.
The annual membership will be extended based on the number of months your account is on hold.
If the request was approved within the first 10 days of the month, you will be refunded for the whole month.
Member's Signature
Clear
Date Signed
-
Month
-
Day
Year
Date
Submit
Approver Section
Approved By
First Name
Last Name
Position/Title
Approver Signature
Clear
Date Signed
-
Month
-
Day
Year
Date
Should be Empty: