Fitness Hold Request Form

Billing Contact *

First

Last

Member *

First

Last

Additional Member

First

Last

Additional Member

First

Last

Additional Member

First

Last

Phone Number *

Email *

Reason for Hold Request (required) *

Financial
Medical/ Injury/ Surgery
Schedule/ Other Activities
Travel/ School

Does this change also include yourself? *

Hold Start Date (the earliest date is the first day of the following month) *

Hold End Date *

Comment or Message

PLEASE READ: Holds are currently granted as a courtesy and do not waive the normal cancellation policy in the Universal Electronic Agreement. I understand hold requests must be for a minimum of 30 days and cannot be processed retroactively. This hold will go into effect the first day of the following month. Cancellations given during a hold period will end the hold immediately, all members on the gym membership will regain immediate access to the gym, and any prorated fees through the end of the month will be immediately due and charged to the credit card on file. The following month will be the final billed month. Each account is allowed up to 90 days of total hold time in a 12 month period, which begins the first day of the hold and resets annually for as long as hold requests are granted. Requests may take up to 72 hours to be fully processed. *

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