Membership Freeze Request

Please complete the below form to request to freeze your membership. Request is subject to receipt and acknowledgement by Rush Copley Healthplex.

Address
Reason for Freeze
Do you have a locker?
If you have a locker, would you like to keep it?
Members may only freeze up to 6 months in a calendar year.
I acknowledge that by freezing my membership I am agreeing to pay a nominal fee of $10 per adult and $5 per child each month in place of regular dues. My membership will automatically reactivate on the date indicated on this form.
I understand cancellation may not occur while on freeze. To cancel, membership will be reinstated for one month to fulfill the required 30 day notice.
I understand if my membership is currently in a contract, my contractual term will be extended by the length of the freeze.