MEMBERSHIP 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 4 month term.  This form is a request.  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

Name(Required)
MM slash DD slash YYYY
MM slash DD slash YYYY
  • • 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.
Consent(Required)