MEMBER PREGNANCY FREEZE FORM

Congratulations on your pregnancy. We will freeze your membership until one month after your due date. All frozen time will be added to the end of your membership term free of charge. 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 confirming your due date*

*Without the doctors letter we cannot process your membership freeze.

Please complete the form below and "Hit" the "Print" button on the bottom. Then print and fax the form along with the appropriate documents to (212) 734-9807 or mail 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.

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

Sincerely,

Lucille Roberts Fitness Clubs
LR Customer Service Department

MEMBER PREGNANCY FREEZE (Please complete this form and return it with the required documents.)
Date:
Membership Number:
First Name:
Last Name:
Middle Name:
Address:
Apt. #:
City:
State:
Zip:
Club Location:
No applications can be accepted without a membership number and complete name. Print and fax this form along with the appropriate documents to (212) 734-9807 or mail to: Lucille Roberts Fitness Clubs, LR Customer Service Department, 1202 Lexington Avenue, Box 333, New York, NY 10028.