Membership Change Form

I am requesting that a change be made to my membership agreement. Please indicate

which of the following changes you would like made by checking one or more of the
boxes below:

Upgrade to a Family Membership

○ Please indicate the names of the family members you would like to have
added:

________________________________________

________________________________________

Downgrade to a Single Membership

○ Please indicate which family member you would like to retain the Single
Membership

________________________________________

Add or Remove a Single or Family Tanning Membership

○ If you have a family membership please indicate which family member’s
account you will like to add or remove tanning from:

_______________________________________

Freeze my membership: (First 3 months free of charge and only $3 per month after
initial period will be applied to my account)

○ Start Date: _______________________

○ End Date: _______________________ (If end date unknown leave blank)

Total monthly cost of changes made to my membership: $____________________

I am the authorized decision maker on this account. Unless otherwise noted above these
changes will be effective immediately. I agree to all the changes noted above in addition
I understand that these changes could impact my monthly membership dues which is also
noted above.

Printed Name Signed Name Date Card Number

Employee Name___________________________________