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Name
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Membership Freeze or Cancellation Options
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I would like to freeze my membership for a period of weeks (min. of 2, max. of 12) due to travel or medical issue.
I have successfully completed my termed membership agreement and wish to cancel.
I am permanently relocating my personal residence more than 25 miles from any Krav Maga Maryland Training Center; And more than 25 miles from my current residence. I have attached one of the following valid proofs of relocation:
I have become physically unable to continue Krav Maga training determined by a doctor. I have had a doctor Or nurse practitioner complete and mail in the Verification of Disability Form.
If requesting to freeze, how many weeks?
Date your freeze will start?
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Month
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Day
Year
Date
Submit any required documents for proof of relocation/travel/injury/disability.
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This can be a lease, utility bill, new driver's license, airline ticket, doctor's note, etc.
Cancel
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I agree that I have read all the terms set forth on the original agreement and acknowledge full responsibility to the terms and conditions stated herein as required for membership and amendment. For freezes only, I fully understand that payments will be frozen for the period of time indicated and payments will resume on the above listed date. I also understand that freezes must be for a minimum of 2 weeks and that any modification to this freeze request requires completion of a new Freeze/Cancellation form. For freezes and cancellations, I fully understand that all requests require 15-day written notice to process freeze or to terminate my membership.
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I agree
E-Signature
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Signing this means you agree to the terms above and everything in this form is factual.
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