Customer Service Information

MEMBER MEDICAL FREEZE FORM

We will freeze your membership for a maximum of 6 months. All frozen time will be added free of charge to the end of your membership term. In accordance with your membership, when your membership is frozen, you must continue to pay your monthly dues.


Please provide us with the following:

Doctor's Letter stating the estimated duration of convalescence.

*Without the doctor''s letter, we cannot process your membership freeze.

Please complete the form below and "Hit" the "Print" button on the bottom. Then print and mail the form along with the appropriate documents to: Lucille Roberts Fitness Clubs, LR Customer Service Department, 1202 Lexington Avenue, Box 333, New York, NY 10028.

If you have any questions, please call our Customer Service Representatives at 212-734-9717, Monday thru Friday 9-12 pm and 1-4 pm.

We hope you feel better and look forward to seeing you back at the club soon.

Please Note: All forms must be FULLY COMPLETE and mailed along with the required documents or we cannot complete your request. No fax, email or other forms of response will be accepted.

Sincerely,

Lucille Roberts Fitness Clubs
LR Customer Service Department

MEMBER MEDICAL FREEZE


(To be completed by member. This form is not to be used by physician to cancel a membership.)
Date:
Membership Number:
First Name:
Last Name:
Middle Name:
Address:
Apt. #:
City:
State:
Zip:
Club Location:
Date of Illness or Injury:
Describe how illness or injury impedes your ability to use the health club:
Estimated duration
of convalescence
1 months
2 months
3 months
4 months
5 months
6 months
No applications can be accepted without a membership number and complete name. Print and mail this form along with the appropriate documents to: Lucille Roberts Fitness Clubs, LR Customer Service Department, 1202 Lexington Avenue, Box 333, New York, NY 10028.