First Name *

Last Name *

Email *

What membership(s) would you like to freeze? *

• Homebody
• In-Person Group Class
• SGPT
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• List is empty.

What day do you want your freeze to start? *

What day do you want your freeze to end? *

Is this an extension of a current freeze? *

• Yes
• No
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• List is empty.

Is this a medical freeze? *

• Yes
• No
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• List is empty.

Bless your heart! Please briefly describe the reason for your medical freeze. *

Do you have a doctor's note? *

Select

• Yes
• No
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• List is empty.

Please upload your doctor's note.

Please check this box: *

I acknowledge that unless my freeze is medical I will be charged $10/week for the freeze, billed at the time of processing.

HERE'S MY FANCY SIGNATURE *

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