Membership Change of Status

Membership Change of Status Form

Please fill out the form below to update your membership status.
Unit #
Member Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
I wish to make the following changes to my account:*

Place Membership on HoldChange Membership TypeUpdate Payment Information for MEMBERSHIPUpdate Payment Information for ECEUpdate Payment Information for BOTHOther
Select which Membership tier you would like to update to:

AdultCoupleFamilyOther
Please explain further so that we can assist with your request
For insurance plans - Include plan name and Fitness ID #
Payment Options

One Time PaymentMonthly PaymentsRefundSystem Credit
Amount
Payment Date(s)
Payment Type (a team member will contact you to collect this information)

Card On FileNew Payment MethodCashCheck/EFT (Include void check)
*Existing payment method will be billed unless noted differently above.
Signature

Clear
Date

MonthDayYear
Date
Please allow 1 - 3 business days for processing membership requests and 1 - 5 business days for external insurance reviews.
For staff use
Method of Communication

In personMail/EmailPhone/Voicemail
Staff Name:
Date of Change:
Should be Empty:

Membership Change of Status Form