Modification Request - Mount Vernon Fitness

Complete this form to request a modification to your existing membership.

Name*
First Last
Phone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Current Membership Type*
Request Type*
Requested Membership Type*
Reason for Cancellation/Freeze Request
Requested Effective Date (30 Days from Current Date)*
MM slash DD slash YYYY
Length of Freeze (Full Months Only; 3 Month MAX)
MM slash DD slash YYYY
Upload File
Drop files here or

Accepted file types: jpg, png, pdf, doc, Max. file size: 100 MB.
Please attach your proof of relocation or medical notice. It is required to process your membership (for annual memberships only).
Satisfacation Rating
- Very Satisfied
- Satisfied
- Neutral
- Unsatisfied
- Very Unsatisfied
Would you recommend MV Fitness to others?
Comments
Terms & Conditions*
- I Agree & Acknowledge
Modification requests may take up to 30 days to process and are not confirmed until you are contacted by an MV Fitness team member after the request has been reviewed and processed. Accounts in arrears must be cleared prior to modifications. Freezing is up to 3 months, free of charge for injury recovery, travel, other medical issues. At the end of the freeze period, access to the club and regular billing will automatically be reactivated. Annual membership terms are extended by the amount of months frozen. Freeze reversal is possible if your situation changes by requesting early reactivation.
30 Day Confirmation:*
- I Agree & Acknowledge
I understand that completing this form is not a confirmation but a request that will need to be reviewed by MV Fitness. Cancellations and modifications can take several weeks to process so requests submitted close to billing date may not be processed before the next billing. We require 30 days notice prior to effective cancellation date.