Name *

First Name

Last Name

Phone *

(###)

###

####

Membership Hold End Date:

MM

DD

YYYY

Membership Change Date - No Earlier Than Today's Date *

MM

DD

YYYY

I understand that a 30-day notice is required for cancellation requests. I also acknowledge that cancellation means I would need to sign up as a new member to rejoin, which includes the standard membership fees *

Yes

By submitting this form, I acknowledge that processing may take up to 24-48 hours and will only be considered complete once I receive a confirmation email from NMA. If I do not receive this, I will promptly contact NMA. *

Yes

I understand that requests must be made at least 48 hours before my next scheduled payment date to avoid being charged. Holds cannot be applied to prepaid classes. Once the hold expires, my membership and payments will automatically resume. *

Yes

I understand I can freeze my membership for 2 weeks to 3 months for a $10 + tax administrative fee per request. (required) *

Yes