Cypher Change Request Form

First Name *

Last Name *

E-mail Address *

What TYPE of Cypher Membership would you like to change? *

Please submit a separate form for each membership your would like to change.

Monthly Group Classes

Monthly Nutrition Coaching

Monthly Personal Training

Monthly Online Coaching

Other:

What is the current Level of your Cypher Membership you would like to change FROM? *

Example: 12X/Month

What is the next Level of your Cypher Membership you would like to change TO? *

Example: 16X/Month

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? *

CHANGE NEXT RENEWAL

TAKE A BREAK AND RESTART LATER

If you would like to take a break for travel or other reasons, when would you like your membership to RESTART?

A Cypher Staff member will reach out to you to confirm your restart before any bills are paid.

YYYY

Please select the best reason for your change request: *

Fitness Goals

Budget

Travel

Schedule

Other:

Additional Questions, Comments, and/or Feedback:

Is a Member or Cypher Staff submitting this form? *

Cypher Staff

Member

Membership Policies *

I have read and agree to the Cypher Health & Fitness Membership Policies, and acknowledge that this form must be submitted by no later than 8PM PST on the 20th day of the current month in order to take effect. . Otherwise your change request will be scheduled for the month thereafter.

Required

Please print your Full Name to e-sign *

Submit

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