Freeze Form

Freeze Form
This electronic version of a freeze form must be submitted 5 business days prior to the month in which you want to freeze your membership. Please refer to our freeze policies for more information. Please allow 2 weeks to receive an e-mail confirmation.
Main Member Name*
First Last
Member ID #*
Number on your Key Tag or Moraine ID
Email Address*
Phone*
Payroll Deduction?*
- Yes
- No
Do you currently have a locker rental?*
- Yes
- No
Are you the only member on the account being frozen?*
- Yes
- No
Please note, if you are the main member, all sub-members will be frozen as well. If you are not the main member, please list all additional members to freeze on the next page.

Additional Freezes
Please list all other members of the household in which you would like to freeze.
#1 - Member ID
#1 - Name
First Last
Please freeze the following for Member #1:
Highlight all that apply
#2 - Member ID
#2 - Name
First Last
Please freeze the following for Member #2:
Highlight all that apply
#3 - Member ID
#3 - Name
First Last
Please freeze the following for Member #3:
Highlight all that apply
#4 - Member ID
#4 - Name
First Last
Please freeze the following for Member #4:
Highlight all that apply
#5 - Member ID
#5 - Name
First Last
Please freeze the following for Member #5
Highlight all that apply
#6 - Member ID
#6 - Name
First Last
Please freeze the following for Member #6:
Highlight all that apply
Please list Member ID, name, and services you wish to freeze of any members not listed above.

Additional Freezes