Modification Request - Mount Vernon Fitness

Use this form to request a modification to an existing membership agreement.

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*
Membership Freeze Terms & Conditions*
- I have read and understand the freeze request terms and conditions.
Freeze policy: Memberships may be frozen for 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. NB: Annual membership terms are extended by the amount of months frozen. Freeze reversal is possible if your situation changes by requesting early reactivation.
Reason for Cancellation/Freeze Request
Requested Effective Date (at least 30 days from current date)
MM slash DD slash YYYY
Length of Freeze: Full months only, 3 month maximum
MM slash DD slash YYYY
Satisfacation Rating
- Very Satisfied
- Satisfied
- Neutral
- Unsatisfied
- Very Unsatisfied
Would you recommend MV Fitness to others?
How can we improve MV Fitness?
Terms & Conditions*
- I Agree
I agree to the terms and conditions. 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.
30 Day Confirmation:*
- I Agree
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.