Name *

First Name

Last Name

Date of Submission

MM

DD

YYYY

Current Class Option *

Virtual Membership

Unlimited CrossFit

3x/week CrossFit

2x/week CrossFit

Change to: *

** Virtual Membership $59

** Annual Prepaid Membership Unlimited $2160

** Annual Prepaid Membership 3x/wk $1800

Unlimited CrossFit

3x/week CrossFit

2x/week CrossFit

Change in Membership Policy *

Updating from one membership to another will update the new membership at the current rate regardless of previous tuition rate.

I understand that changing my membership will update to the current rate/tuition for that membership.

Add ons:

V10 Nutrition

Private Training (10 one-hr sessions) $500

Private Training (5 one-hr sessions) $250

Private Training (1 one-hr session) $50

Name *

First Name

Last Name

Date of Submission

MM

DD

YYYY

NOTICE *

A copy of Defiant's cancellation policy can be found in your red folder that you received during your New Athlete Orientation.

I understand that it is my responsibility to submit this form with a 15 days notice.

I understand that by submitting this form with less than 15 days notice will result in my automatic payment being billed to my account.

I understand that there are no refunds for paid fees, regardless of circumstances.

FEES *

Cancellation of your onsite training prior to the expiration of your initial 3 months commitment period requires an early termination fee equal of $150 regardless of circumstances unless due to severe injury requiring hospitalization or surgery. I understand that a Cancellation fee will be applied to my account at the time of cancellation. * There are no cancellation fees for Virtual Memberships.

I understand the Cancellation Policy.

REACTIVATION *

If you choose to reactivate your training in the future (and we hope you do!), rates in effect at the time of reactivation will be applicable as rates are subject to change.

I understand that reactivating my membership in the future will incur rates in effect at the time of reactivation.

Name *

First Name

Last Name

Date of Submission

MM

DD

YYYY

SUBMISSION *

Holds must be submitted no less than 7 days prior to your next billing date. Requests received after this time will not be processed until the following billing date. All payments are non-refundable.

I understand that a Hold request must be submitted no less than 7 days prior to the Hold date in order to suspend the next scheduled payment.

REACTIVATION *

Upon expiration of your requested Hold period, your account will automatically reactivate and regular payments will resume.

I understand that my membership and payments will automatically resume upon expiration of my requested Hold period.

I understand that canceling my membership during the Hold period will apply the standard cancellation fees to my account.