Membership Hold and Cancellation Request

Fencer Name *

First Name

Last Name

Phone

(###)

###

####

Current Program

Youth Epee

Teen/ Adult Epee

Beginner Saber

Advanced Saber

Hold or Cancellation?

Hold (Temporary pause on membership with preset restart date. A $50 hold fee will be charged to the account.)

Membership Cancellation (Terminate classes and programs, including private lessons, 14 days from the date of this notice submission.)

If holding, please provide a membership restart date. If cancelling, please provide a termination date.

MM

DD

YYYY