NAME *

First Name

Last Name

PHONE NUMBER *

(###)

###

####

WHEN WOULD YOU LIKE THIS PAUSE TO TAKE AFFECT? *

Must be at least ONE week from today's date. If it isn't this will automatically occur.

MM

DD

YYYY

WHEN WOULD YOU LIKE THE MEMBERSHIP TO REACTIVATE? *

Must be at least ONE week from the initial pause date.

MM

DD

YYYY

I UNDERSTAND THAT HOLD REQUESTS MUST BE SUBMITTED NO LESS THAN 7 DAYS BEFORE MY REQUESTED START DATE. *

I AGREE.

I UNDERSTAND THAT MY MEMBERSHIP WILL RESUME AUTOMATICALLY UPON EXPIRATION OF THE HOLD PERIOD THAT I SELECTED ABOVE. *

I AGREE.