Freeze/Unfreeze Form

All freezes must be received 10 days before next due date.

Today's Date*
Month
Day
Year
Membership or Key Tag #*
This is the barcode number that appears on the card you use to check-in. If you do not have this number you must come into the club to complete your request.
Please choose one:*
- I want to freeze my membership.
- I want to end my freeze.
Please choose one:*
- Freeze all membership charges
- Freeze club access only
- Freeze virtual membership only
Club Location*
Name*
First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Birth Date*
MM slash DD slash YYYY
Cell Phone
Home Phone*
Work Phone
Emergency Contact Name*
First Last
Emergency Contact Phone*
Freeze Start Date*
MM slash DD slash YYYY
Requested Freeze End Date
MM slash DD slash YYYY
Reason for Freeze*
Document Upload
Max. file size: 128 MB.
I agree that prorated dues will be charged in accordance with my freeze start and end dates and that club enhancement fees will continue to bill while my membership is on freeze. Membership can be frozen for a maximum of 3 months in any 12 month period. Medical freezes can be extended with physician note. If you do not select a freeze end date, your membership dues will be automatically suspended for two months or the maximum allowable period per your membership agreement. After that period, billing will resume and you will have access to the club.*
I agree
I (the member), hereby authorize World Gym to initiate the above changes to my membership account. This form serves as an addendum to your (the member’s) contract with this health club. I understand that I must give World Gym a 31 day notice to validate any changes requested. The changes made herein are binding under the terms of the original membership agreement.
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