Out of Town Freeze Form OUT OF TOWN FREEZE FORM To request a temporary membership freeze, please fill out the form below. Today's Date Membership Barcode ID# First Name Last Name Email Freeze Start Date Freeze End Date Reason for Freeze The minimum amount of a freeze time is One Month. The maximum amount of a freeze is Three Months. Your account must be current with monthly dues to qualify for a freeze. Please be advised that the monthly payments of your membership dues will continue as scheduled during a freeze. Membership freeze time will NOT be backdated. Freeze Time is Non-Refundable. Exceptions – Freezes DO NOT apply to the following memberships: $10 Promotional Membership, IHA Healthy Benefits, Silver Sneakers or Silver & Fit. Please indicate if you currently have monthly deductions for a personal training account by checking yes or no. YesNo By checking this box you acknowledge and agree to the terms listed above. SUBMIT
