Freeze Request Form
Please include your first and last name.
Located on the back of your scan card (e.g. x55555)
Which accounts would you like to freeze?
Both (accounts at same club)
Both (accounts at different clubs)
6 Months (Pregnancy only)
For freeze requests longer than 3 months during the 12 month period, supporting documentation must be provided for consideration (i.e. doctor's note, school enrollment, proof of pregnancy, etc).
Please select the box below to receive email confirmation of your Freeze Request.
Send me a copy of my responses
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