Membership Change of Status Form
Please fill out the form below to update your membership status.
Unit #
Member Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
I wish to make the following changes to my account:
*
Add Club J ($14.50/m)
Place Membership on Hold
Change Membership Type
Update Payment Information for MEMBERSHIP
Update Payment Information for ECE
Update Payment Information for BOTH
Other
Select which Membership tier you would like to update to:
Adult
Couple
Family
Other
To add family members - list names and date of birth
Please explain further so that we can assist with your request
For insurance plans - Include plan name and Fitness ID #
Payment Options
One Time Payment
Monthly Payments
Refund
System Credit
Amount
Payment Date(s)
Payment Type (a team member will contact you to collect this information)
Card On File
New Payment Method
Cash
Check/EFT (Include void check)
*Existing payment method will be billed unless noted differently above.
Signature
Date
-
Month
-
Day
Year
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 person
Mail/Email
Phone/Voicemail
Staff Name:
Date of Change:
Submit
Should be Empty: