MEMBER NAME *

Please provide the name of the member or student.

First Name

Last Name

Phone *

(###)

###

####

Date you would like change to go into effect: *

Note: Dropping down to a lower membership package requires a 30 day notice, payments scheduled within that time frame will still process.

MM

DD

YYYY

By checking this box: *

I acknowledge that I am entering into a new membership agreement that will auto renew until I submit a cancellation notice at least 30 days before my payment draft date.

By checking this box: *

I acknowledge that memberships being dropped to a lower rate require a 30 day notice and changes will go into effect 30 days from today.