Membership Changes Type of Account Change*Select from the following options:FreezeCancellationType of Freeze*Select from the following options:Freeze MembershipFreeze ServiceFreeze Membership and ServiceType of Cancellation*Select from the following options:Cancelled MembershipCancelled ServiceCancelled Membership and ServiceReason for Freeze*FinancialNo TimeMedicalMoveRewriteOtherReason for Cancellation*FinancialNo TimeMedicalMoveRewriteOtherNotesDuration of Freeze*One MonthTwo MonthsFull Name* Email* Agreement Number or Barcode (can be found in the FP app)* Club Location*Beecher 6752Bourbonnais 6793Cedar Lake 6756Champaign 6796Coal City 40030Crete 6754Geneseo 40107Homer Glen 40036Mahomet 40001Manhattan 6746Manteno 6739Minooka 6794Monee 6742Monticello 40098Morris 40139Plainfield 40073Pontiac 6768Upload doctor's note or deployment papers*Max. file size: 50 MB.Terms of Freeze* I agree to the terms of freeze. I understand that I am submitting a freeze request. If my freeze request is approved, my account will be placed on hold for the amount of time requested. My recurring payment will automatically continue after the length of the requested freeze term. If my Annual Maintenance Payment is scheduled during the freeze term, I will be billed for that payment. If my membership is a term membership the frozen months will be added to the end of the term.Terms of Cancellation* I agree to the terms of cancellation. I understand that I am submitting a cancellation request. If my cancellation is approved, my cancellation will go into effect 30 days from the next billing date as stated per my month to month agreement. If my agreement is in a term, my cancellation will be set to process at the end of the term as stated per my term agreement. I authorize Fitness Premier to process any fees associated with my account, including any past due balance, final membership dues, or final service dues. I understand that if any of these charges are returned for any reason my cancellation request will be voided and the membership will be reinstated.Electronic Signature* By typing your name above, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this Agreement.
