Crunch Membership Request Form

Crunch Membership Request Form

Please Note: This DOES NOT give you membership to Crunch. This form is sent to Crunch to verify eligibility and complete the membership process.
Name*

First NameLast Name
E-mail*
example@example.com
Cell Number*
Are you a member of the YourChoice Health Plan (or will be effective 1/1/2026)*

YesNo
Only members on the YourChoice Health Plan are eligible for this Crunch Membership.
Are you a current member of Crunch?*

YesNo
Crunch members need to give a 30 day notice no later than December 1, 2025 in order to receive the YourChoice Crunch membership effective 1/1/2026. Failure to provide 30 day notice to Crunch, will result in continuation of membership dues.
Should be Empty: