Member’s Full Name *
Member’s E-Mail *
Hold Start Date *
Hold End Date *
Reason for Hold *
I understand that my draft will automatically restart after my hold period. *
I understand that I may hold my account from 1-30 days. *
I accept that a $20 hold fee will apply. * (This will be void if you submit a Doctor’s note.) *
I understand that my hold cannot be applied retroactively and I must allow at least 5 days for the hold to be applied to my account. *
I understand that if I cancel during the hold period, I must submit a separate cancellation form and it will be subject to the Cancellation Policy per my Membership Agreement * *
0 + 4 = ? Please prove that you are human by solving the equation *
Reason for Cancelation *
I am canceling because of: IllnessFinancial burdenMovingDo not useUnsatisfied with programs or serviceJoined another facilityOther
By submitting this form, I am giving Indigo Yoga my 7 day written notice to cancel my membership. I understand that my membership will be canceled 7 days from the date this form was submitted. I understand that if I did not fulfill my contractual obligations with Indigo Yoga, I will not be reimbursed my deposit. Upon completion of the 7 day cancellation period, my membership shall then be considered terminated. Should I choose to rejoin Indigo Yoga after the termination of my membership, I will have to pay at the then current rate.
4 + 3 = ? Please prove that you are human by solving the equation *
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