Membership Freeze Request
Member Name
*
First Name
Last Name
Participant Name (if different than member)
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Date Freeze to Commence
*
-
Month
-
Day
Year
Date
How many months would you like to freeze?
*
1
2
3
Other
Medical Reasons?
*
Yes
No
Will you be traveling during the freeze?
*
Yes
No
If neither medical nor travel, what is the reason for the freeze?
Please explain
I understand that if I wish to resume my VSC activities early, before expiry of the freeze, I must notify the VSC Management so my account can be unfrozen.
*
Yes
No
Member Signature
Submit
Should be Empty: