FREEZE FORM


Primary Member Information
Member Name *
Member Name
Todays Date *
Todays Date
Secondary Member Freeze Option
Secondary Member Freeze
Secondary Member Freeze
Freeze Information
Date to Start Freeze *
Date to Start Freeze
Date to Re-Instate Payment *
Date to Re-Instate Payment
Services to Freeze *
Freeze Policy *
By clicking yes I am taking advantage of the ability to freeze my current membership for a maximum of 3 months in a 12 month calendar year and will not take advantage of any services within this time frame. I understand that as a monthly billed member I can only freeze from bill date to bill date. The minimum amount of time I am able to freeze is one full month. The maximum without a Dr's note is 3 months.If any services that are frozen are used while on a freeze, I understand that I will be charged at full price. I understand that at the end of my freeze my billing will be fully reinstated and will continue to bill appropriately. I understand that I will not be eligible for a refund if I do not extend or cancel my membership before my membership is reinstated ( see bill date). I also understand that with all membership freeze's the annual enhancement fee will still be charged regardless of the freeze reason.