Cypher Change Request Form
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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.
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? *
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.
Please select the best reason for your change request: *
Additional Questions, Comments, and/or Feedback:
Is a Member or Cypher Staff submitting this form? *
Membership Policies *
Please print your Full Name to e-sign *
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