Which program do you wish to reactivate/reinstate?:
MMAStrikingWomen's KickboxingJiu-JitsuReality Based MMA
Students Name (First, Last): (required) Account Holder's Name. *Who is Paying* (First, Last): (required)
Your Email: (required)
**You will receive a confirmation email.**
Type of Account: Bank AccountVisaMaster CardDiscoverOther Name on Account: Last 4 Digits of Account/Card Number:
I UNDERSTAND (required):
1. All memberships require 31 days written notice to cancel and a minimum of two full paying months after this reinstatement has been made. I understand that I will only be charged $25 per month for three months (June, July & August 2014) which will fulfill the "two full paying months" per the special I am signing up for.
2. By checking the following box I understand and agree to the Membership Policies and have read the FAQ regarding our rules, payments, cancellations, holds, etc.
3. I agree and confirm that I am 18 years or older and if I am not the student who this addition is concerning, I confirm that I am the parent or legal guardian of the above student.
4. I understand that if I am reinstating an account under the special above and the normal $75 reinstatement fee will be waived this time. However, if I cancel and come back, an account which was previously canceled I will incur a reinstatement fee of $75.
5. I understand the my account will be charged $25 for June 2014, $25 for July 2014 and $25 for August 2014. Starting in September 2014 I will automatically get charged the special rate of $75 per month for the program above I am signing up for unless I submit my 31 days notice for July to be my last month.
I UNDERSTAND AND AGREE TO ALL OF THE ABOVE:
Please type in the letters below:
Then click "Send" below: