M-F Membership

Membership Cancellation or Freeze Form

Date of Request:

Request Type:

Club Name: Club #:

Member Signature:

Cancellation and Freeze Rules

•

•

If your membership has a “minimum term”, and you wish to cancel prematurely, a “Buy Out fee” is required for cancellation.

Freezing your membership does NOT freeze your Annual Maintenance fee. Your current Annual Fee will still be applied on the applicable date according to your membership.

• To extend the freeze after “1stBill Date after Freeze” a new doctor’s note must be attained.

• If unfreezing before the “1stBilling Date after Freeze” you will be responsible for any prorated dues until the next billing date.

Employee Name:

Membership #: Member First and Last Name: Join Date: Monthly Dues Amount: Balance Due: Email Address: Last Check In Date: New Address (if applicable):

Request effective

Date:

Cancel Reason: Last Bill Date:

(if applicable)

1stBill Date after Freeze:

(if applicable)

Doctor’s Note for Freeze:

(if applicable)

Buyout Fee Paid

(plus applicable tax)

Total Due Today:

(if applicable)

Last Day to use Club:

Comments or Suggestions:

0.00

VALERIE MARION

Cancel

05/03/2023

05/16/2023

nicholas johnson

072*******-**/09/2023

02/09/2023

04/16/2023

******@******.***

0.00

05/03/2023

Towson 07211

CANCEL

0.00 0.00

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