Membership Freeze Request
Member Name
*
First Name
Last Name
Email
*
example@example.com
Date Freeze to Commence
*
-
Month
-
Day
Year
Date
How many weeks would you like to freeze?
*
1
2
3
Other
Why would you like to freeze?
*
Please explain
Medical Note Provided
*
Yes
No
Will you be travelling during the freeze?
*
Yes
No
If yes, where are you travelling too?
Please explain
I understand that my account must be in good standing to qualify for a freeze
*
Yes
No
I understand that if I wish to resume my gym activities early before expiry of the freeze, I must notify the CrossFit Electify 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
File attached (such as medical proof)
Browse Files
Cancel
of
Member Signature
Submit
Should be Empty: