Modification Request | Coastal Fitness

Use this form to request a modification to an existing membership agreement at Coastal Fitness.

Name*
First Last
Phone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Request Type*
Requested Membership Type
Membership Freeze Terms & Conditions*
- I have read and understand the freeze request terms and conditions.
Freeze policy: Suspend membership dues billing for 2-3 months --> fee is $25.00. Suspend membership dues billing for 4-6 months --> fee is $50.00. Medical freezes have a fee of $0.00. Notice to Freeze must be submitted, reviewed, and processed by a manager on duty. Member must be present and sign for the final confirmation with the manager on duty. At the end of the Freeze status the membership and it's billing will automatically be reactivated.
Reason for Request*
Requested Effective Date
Satisfacation Rating
- Very Satisfied
- Satisfied
- Neutral
- Unsatisfied
- Very Unsatisfied
Would you recommend Coastal Fitness to others?
How can we improve Coastal Fitness?
Terms & Conditions*
- I Agree
I agree to the terms and conditions. Modification Requests are not confirmed until you are contacted by an Coastal Fitness team member after the request has been reviewed and processed. Freeze requests require additional fees with the exception of freeze requests for medical reasons.
30 Day Confirmation:*
- I Agree
I understand that completing this form is not a confirmation but a request that will need to be reviewed by Coastal Fitness. Cancellations and modifications can take several weeks to process so requests submitted close to billing date may not be processed before the next billing.