MEMBERSHIP FREEZE FORM  
 
Complete the form below to submit your freeze request.
   
FIRST NAME:
 
 
 
PHONE NUMBER:
 
SCAN TAG #:
 
LOCATION:
Englewood
Montvale
 
Reason for freeze request:
 
TERMS and CONDITION:
 
By checking the "Terms and Conditions" box and clicking the "Submit" button on this page, I acknowledge that in order to freeze an Annual Membership, I am obligated to complete this form and provide THE GYM, upon request, with a current valid Physician’s note stating a freeze of membership for medical purposes is necessary. A freeze is effective upon the next billing date for one month or more: maximum of six (6) months. I acknowledge that billing is temporarily postponed during the length of the freeze only. As Annual Member, I acknowledge that I am responsible for the remainder of the membership fee under the Member Agreement regardless of the length of freeze. In addition, if my membership is on freeze for six (6) months or more, I must provide THE GYM with a current valid Physician’s note upon the expiration date on the six (6) months period. Failure to do so will result in an automatic reinstatement of monthly membership dues for the remainder of the Membership Agreement. Freezes cannot be initiated retroactively. 30 days’ written notice prior to billing date is required for all freezes. To request a freeze, I must (1) submit this electronic form to THE GYM at least 30 days before the requested freeze is to begin and (2) be current on all dues, fees and other charges against account. I acknowledge that the above information is accurate and correct. Any misrepresentations with the current information are the sole responsibility of the undersigned. Furthermore, I understand that the freezing of my membership will be executed as per the terms and time frame outlined in my membership agreement. I understand that certain membership types are subject to increases in initiation fees, membership dues, freeze fees, etc. Lastly, I authorize THE GYM to charge my credit card that is on record with THE GYM for any outstanding balances that remain on my account upon the successful freezing of my membership.
   
I understand that this is only a request for freeze of membership and the freeze date of my membership will be communicated to me upon the successful review of my membership agreement and account by a membership account representative of THE GYM.
   

 
 

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