Membership Freeze Request

Membership Freeze Request
This form is to request a freeze on your membership. A member specialist will review your request shortly. Please remember memberships can only be frozen for medical purposes for up to two months per year. Medical documentation is required from a healthcare provider if the membership needs to be frozen for more than 2 months. The documentation will need to have participant name, and expected recovery date.

Note: Please do not send any confidential medical documents through our portal.
Members Name:*

First NameLast Name
Parent/Guardian Name:
Account Email:*
Phone Number:
Reason for request:*
Membership Type

ASCRegularTeams
Do you have any reservations that need to be cancelled?*

YesNo
Payment Due Date*

MonthDayYear
Date
Expected Recovery Date:*

MonthDayYear
This will be the day we reactivate your membership
If recovery takes longer than 2 months, please upload the Doctor's note with expected recovery time:

*Please do not upload any documents with confidential information!
Cancelof
Signature*

Clear
*Please note, if you do not receive an email within 5 minutes confirming your submission, check your internet connection and re-submit after checking your junk/spam folder.

THANK YOU!
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