Student's Full Name *

Email *

Phone *

Membership Hold Start Date *

Membership Hold End Date *

Reason for the hold *

Please check all boxes *

I understand that hold requests must be submitted no less than 15 business days before my next billing date.

I understand that my non-refundable renewal payment may be processed if this request is submitted less than 15 business days before my renewal date.

I understand that if I cancel my membership during the hold period, the 30 day notice required by my membership agreement is still applicable and I may owe up to one full month.

I understand that my membership and non-refundable payments will resume automatically upon expiration of the hold period that I selected above.

I acknowledge and accept the terms of the hold.