Membership Hold / Cancellation Form

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Thank you for being in our community and we hope you've enjoyed your time with us. Moxy hopes you will be able to join again soon.

Please fill out this form 7 DAYS or more PRIOR TO YOUR UPCOMING RENEWAL DATE.

CANCELLATIONS of Memberships require $25 fee and will be charged to the account.

HOLDS may be placed on a Membership for medical, travel or other emergencies lasting longer than 2 weeks. Membership may be placed ON HOLD UP TO 3 MONTHS & may be reactivated anytime,

HOLDS require $10/month fee.

Email *

Member Name in Moxy Account:

I would like to:

Hold Monthly Membership

Cancel my Monthly Membership

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Reason for HOLD / CANCELLATION:

Not having enough time.

Availability of classes.

Moving or changing jobs.

Types of classes offered are not of interest to me.

Financial reasons.

Other:

FOR HOLDS: Please specify the amount of time you wish to place your Membership on HOLD.

Less than 1 month

2 months

3 months

Other:

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What is the Date of your Upcoming Next Billing Cycle?

YYYY

I understand that my account will continue to be auto drafted until I submit this completed form as my request for cancellation or suspension, in writing 10 days prior to the requested cancellation or suspension date.

Yes

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I understand that refunds WILL NOT be given for cancellation or hold requests received AFTER the auto draft has been processed as per my Membership contract.

Yes

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We are always looking to improve our class & community experience. Please leave us any other thoughts or suggestions, we appreciate your participation and feedback.

Send me a copy of my responses.

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