CrossFit Cypher Change Request Form
First Name *
Your answer
Last Name *
Your answer
E-mail Address *
Your answer
What TYPE of Cypher Membership would you like to change? *
Please submit a separate form for each membership your would like to change.
What is the current Level of your Cypher Membership you would like to change FROM? *
Example: 12X/Month
Your answer
What is the next Level of your Cypher Membership you would like to change TO? *
Example: 16X/Month
Your answer
Would you like to CHANGE your next membership renewal (i.e. 1st of next month), or take a break and RESTART your membership at a future date? *
If you would like to take a break for travel or other reasons, when would you like your membership to RESTART?
Note: This date must be at least 2 weeks after your current membership ends. Your next membership will be pro-rated based on the date you specify.
Please select the best reason for your change request: *
Additional Questions, Comments, and/or Feedback:
Your answer
Is a Member or Cypher Staff submitting this form? *
Membership Policies *
Please print your Full Name to e-sign *
Your answer
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