Name *

First Name

Last Name

Phone

(###)

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Please select if you would like to cancel or freeze your membership: *

Read and acknowledge the statement that applies to you.

CANCEL MY MEMBERSHIP: I understand that by canceling my membership I will no longer have access to my current membership rate or any of the benefits, discounts, and classes associated with a Yoga Room Hawaii membership. I accept that membership prices may be different if I choose to return in the future. I understand that my membership will be cancelled as of my next billing date unless I specify a later billing date below.

FREEZE MY MEMBERSHIP: I understand that my membership can be frozen for one month periods (up to 3 months per year) based on my billing cycle date and that my membership will be frozen starting with my next billing date. After my freeze is over, I will be automatically charged my current membership rate. I acknowledge that I will need to submit a separate cancellation request if I choose to permanently cancel my membership during the freeze period.

If you are cancelling your membership, please confirm the date you would like your membership to end.

Your membership will be cancelled as of your next scheduled payment date unless you specify a later billing date below.

MM

DD

YYYY

If you are freezing your membership, when would you like it to reactivate?

You can freeze your membership for up to 3 months in a calendar year. Your freeze will begin with your next scheduled billing date.

MM

DD

YYYY