CLUB URBANA STATUS CHANGE FORM

Please complete the form below to help us serve you.

You are currently enrolled in our Club Urbana Membership Program. We require a 30-day notice to terminate or freeze your membership; after the initial 6 or 12 month term. This form is a request. AFTER YOU HAVE SUBMITTED THE FORM, PLEASE PRINT A PDF/HARDCOPY OF THE FORM THAT SAYS "Thank you for your submission! Please save a copy of this submission as proof of date and time of submission."

Please note the date of your scheduled monthly payment, as there might be a final payment to be processed. Any banked packages you may have accumulated will only be accessible to you for 3 years from the originally package purchase date. Membership packages/ members discounts are non-transferable. If you have any questions or need to make a reservation, please call your spa at 704-543-1700

FOR YOUR CONVENIENCE, WE ALSO OFFER THE OPTION OF FREEZING YOUR MEMBERSHIP:

Membership Freeze Option - A membership may be frozen for a minimum of one month and a maximum of three months with no additional cost.
Memberships can only be frozen two times in a 12 month period for a maximum of 3 months at a time. A membership must be unfrozen a minimum of 30 days before it can be frozen again.
Members can redeem accumulated services during a freeze but cannot utilize any additional membership benefits (i.e. bringing guests, gift card purchases, retail discounts).
A minimum of four Auto Draft Payment must have been made before a membership is eligible to be frozen.

I am hereby requesting that the Membership terminated or frozen as indicated below.

Personal Information

First Name

Cell Phone

Address

Last Name

Birthday

Requested Status Change Effective Date*

•I will no longer be eligible for Membership or product benefits.

•My termination is not effective until a Termination Request has been submitted and received by Urbana Spa, per my membership contract.

•As a Primary Member responsible for a Family or Household membership, when I terminate my membership, add on members associated with my account will be adjust to full membership pricing.

•As an add-on Member, I may terminate my membership independent of the Primary Member.

•Termination Request must be received by the 20th of the month prior to Termination Effective date.

•No refunds are allowable. (Urbana - Please understand that you can convert your balance into a gift card so that you can re-gift to another customer of your choice.)

•Should I determine at a future date to resume my membership, I will be charge at new membership pricing should there be an adjustment.

Reason for Termination (We value your feedback)*

I agree to the terms & conditions

Thank you for your submission! Please save a copy of this submission as proof of date and time of submission.