Membership Change Request Form

Membership Change Request Form

Please note that any change requests made to your membership will be reflected the following month.
Adult/Legal Guardian Name*

First NameLast Name
Child Name*

First NameLast Name
Upgrade/DowngradePause Membership (limited to 1 billing cycle)Cancel Membership
Current Membership Type*
New Membership Type*
Cancellation Start Date:

Please note that 15 days notice is required for all membership cancellations. If this form is submitted after the 15th of the month, and you are cancelling for the following month, you will be charged a $50 expedited processing fee.

If you have any questions or require further information, feel free to reach out to us via email at accounts@poppyvocalstudio.com. We're here to assist you with any inquiries you may have.
Effective Month of Change*
Reason for Pause*
We appreciate ALL feedback!
Reason for Cancellation*
We appreciate ALL feedback!
Teacher*
Last Four Digits of Credit Card*
For verification purposes only
I, {adultlegalGuardian}, as a cardholder, hereby authorize Mattox Voice LLC DBA Poppy Vocal Studio to make the changes stated above to my monthly membership. By signing my name I agree to the terms and conditions.
Today's Date*

MonthDayYear
Cardholder Signature*

Powered by Jotform SignClear
Email*
example@example.com
Should be Empty: