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Received by: ________ Date: ________

MONTHLY UNLIMITED AUTO RENEW SERIES

FREEZE AND CANCELLATION REQUEST FORM Our Auto-Renew Series combines unlimited classes with the convenience of automatic renewal. Auto-Renew memberships require the following minimum commitment • $109 per month requires 3 months minimum • Family auto renew requires 6 month minimum • $99 per month (or discounted rates) requires 6months minimum where NO FREEZING OR CANCELLATIONS ARE PERMITTED during the initial term.

After the initial term, to freeze or cancel your Auto-Renew Series a completed request form must be submitted at least 30 days in advance of your next billing date in order for your request to be effective for the following month. Billing date is based on your Auto-Renew Series Activation Date recorded on your original contract. Requests submitted in less than 30 days will not be honored. _______________________________________________________________________________________________________

FREEZE FORM Bikram Yoga Meyerland Plaza Auto-Renew Series Freeze Policy:

• You can freeze your Auto-Renew Series payments once a year. The minimum duration allowed for a freeze is 1 month and the maximum duration for a freeze is 3 months. A $10 Freeze Fee will be charged each billing date you are gone and will be charged to your credit card on file.

• To request the freeze, this form must be completed and either emailed to [email protected] or submitted in person • Following the end of your requested freeze period, your Monthly Auto-Renew Series will automatically be reactivated. Please note that your billing date may by shifted to another cycle date depending on the length and when you freeze your membership. In order to process your freeze request correctly, please complete all the information below and please be sure to sign and date the bottom of the form.

Student Name:____________________________________ Freeze Start Date: _________________________________ Freeze End Date: _________________________________ I have read and understand the above policies and agree to those terms. Print name here: _____________________________ Today’s Date:________________________

Signature:___________________________________

Staff Use: Staff Intials ________ Billing date shift date ____________ Site Sup/Mgr - checked for correct entry in MB? _________

Revised 11/13/2015

MONTHLY UNLIMITED AUTO RENEW SERIES

FREEZE AND CANCELLATION REQUEST FORM CANCELLATION FORM Bikram Yoga Meyerland Plaza Auto-Renew Series Cancellation Policy:

• To request the cancellation, this form must be completed and received by Bikram Yoga Meyerland Plaza at least 30 days prior to the next billing date in person OR scanned and emailed to [email protected]. In order to process your cancellation request correctly, please complete all the information below and please be sure to sign and date the bottom of the form. Student Name:____________________________________ Billing Address: ______________________________________ City, State, Zip___________________ Effective date of cancellation: ________________________(to be filled in by staff) Reason for cancellation: _________________________________________________________________________ I understand that I am canceling my Monthly Unlimited Auto-Renew Series in agreement with the cancellation terms stated above. Signature:_________________________________________________ Today’s Date:_____________ Staff Use: Cancellation/Termination effective from _________________ Notification Email sent? __________________ Cancellation# ____________ Staff Intials ________ Site Sup/Mgr - checked for correct entry in MB? _________

EARLY BUY OUT FORM Bikram Yoga Meyerland Plaza Auto-Renew Series Early Termination Policy:

• Early Buyout: If at any time you wish to terminate your Auto-Renew Series contract before you reach the initial term commitment, you can buy out of it by paying a $100 termination fee. Your membership will end on the effective date recorded below. To request the early termination, a completed Early Buy Out form must be submitted to Bikram Yoga Meyerland Plaza. In order to process your early termination request correctly, please complete all the information below and please be sure to sign and date the bottom of the form. Student Name: ____________________________________ Billing Address: _______________________________________________ City, State, Zip___________________ Effective date of termination:_______________________ (to be filled in by staff) 
 I am unable to fulfill my minimum commitment on my Monthly Unlimited Auto-Renew Series Agreement and am aware that I am responsible for complying with the Early Buyout terms stated both in my original agreement as well as above . I am terminating my contract by submitting this completed form and authorize Bikram Yoga Meyerland Plaza to charge the $100 Early Termination Fee immediately to my credit card on file. In doing so I will continue to be in good standing with Bikram Yoga Meyerland Plaza. 
 Signature:___________________________________ Today’s Date:________________________

Staff Use: Cancellation/Termination effective from _________________ Notification Email sent? __________________ Staff Initials ________ Site Sup/Mgr - checked for correct entry in MB? _________ Revised 11/13/2015