Freeze Form

Future Students

Undergraduate Students

Graduate Students

Parents & Family

Alumni

Faculty & Staff

Researchers

Patients

Colleges & Schools

Today's Date: (*)

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First name:(*)

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Household Members First Name:

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Household Members First Name:

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Minor Members First Name:

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Minor Members First Name:

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Middle Inital(*)

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M.I.:

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M.I.:

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M.I.:

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M.I.:

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Last Name(*)

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Last Name:

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Last Name:

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Last Name:

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Last Name:

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More than two Household Members or Minor Members, please list here:

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Payment Method:(*)

Credit/Debit

Payment in Full

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Address

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Phone Number (Between 8am – 5pm):(*)

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Email:(*)

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Please take a moment to tell us why you are freezing your monthly deductions:

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When freezing your membership, you must provide the Office of University Recreation prior to the 1st of the month which you would like frozen. For example, if you plan to freeze your membership on September 1, you will need to return this form on or before August 31. You can freeze your membership as many times as is needed, but you must freeze for a minimum of 1 month or a maximum of 6 months.

Freeze Start Date:(*)

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Re-Start Date:(*)

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(*)

By selecting this box, I am stating that I acknowledge the below as my official signature and I agree to UAB University Recreation Policies and Procedures in full.

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Type Name:(*)

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I agree to the above Rules and Regulations(*)

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