Modification Request

Name*


Phone*

Email*

Address*






Current Membership Type

Request Type

Requested Effective Date

Satisfaction Rating

 Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied

Would You Recommend the Edgewater Fitness to Others?

 Yes No

How Can We Improve Edgewater Fitness?

Terms & Conditions*

 I agree

I agree to the terms and conditions. Modification requests are not confirmed until you are contacted by an Edgewater Fitness team member after the request has been reviewed and processed. Freeze requests require additional fees with the exception of freeze requests for medical reasons. Although membership dues payments stop during a freeze, annual enhancement fees will continue to be charged per the contract.

Submitted According to Membership Agreement*

 I agree

I understand that completing this form is not a confirmation but a request that will need to be reviewed by Edgewater. I know that I need to submit my request by the 5th or 25th according to my membership agreement. Cancellations and modifications can take several weeks to process so requests submitted close to billing date may not be processed before the next billing.