Member Name*

First Name Last Name

Email*

example@example.com

Date*

Date

How many months would you like to freeze?*

1 2 3

Why would you like to freeze?*

Please explain

I understand that my account must be in good standing to qualify for a freeze*

Yes No

I understand that I will not have access to Anytime Fitness during the freeze and my membership will auto unfreeze after the freeze expires.*

Yes No

I understand that if I wish to resume my gym activities early before expiry of the freeze, I must notify the Anytime Fitness Staff to my account can be unfrozen.*

Yes No

I understand that if I wish to cancel during of after my freeze the regular cancellation policies will apply.*

Yes No

Member Signature

Clear

Membership Freeze Request