Freeze Membership

Name *

First Name

Last Name

Date of requested freeze START date: *

MM

DD

YYYY

Date of requested freeze END date: *

MM

DD

YYYY

I understand that: *

Please read and check all boxes below.

I can freeze my membership for a minimum of 14 days and at most for 30 days for non-medical related freezes each calendar year.

I must give a 7-day notice to freeze my membership. If I’m requesting a freeze within 7 days, I may automatically be charged on my normal billing date, but my next billing date will be pushed back accordingly.