Membership Freeze Request Form

Membership Freeze Request Form
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Daytime Phone*

Area CodePhone Number
Names of Members who will be freezing: *
1. Memberships may be frozen for a minimum of one (1) month and a maximum of four (4) months.

2. I understand that I must contact Hockessin Athletic Club prior to the end freeze date requested if I wish to extend the freeze.

3. I understand that I must submit this form on or before the 30th of the month to avoid a debit of next months dues.

4. I understand that if I have a recurring department EFT, it is my responsibility to inform those respective departments of my intentions to freeze or not freeze those services, if available.

5. I understand this form will not be processed without requested freeze dates completed in the box below.
Begin Freeze*

MonthDayYear
Must fall on the 10th of the month
End Freeze*

MonthDayYear
Must fall on the 9th of the month
Comments
I have read and understand the Hockessin Athletic Club (HAC) Freeze Policy and Agree to be bound by its terms.
Member Signature*

Clear
Date

MonthDayYear
Date
Should be Empty: