Al Ain Ladies Club

Freezing Request Form

Date: _________________________

* Membership Freeze is a courtesy provided by the Club that extends the terms of a membership
agreement for a period of time during which a member cannot use the facilities of the gym.
*Request for freezing must be submitted minimum of one week before effective date.
*Maximum of 3 months is free of charge. However, any late requests will be charged 105 AED per month.
*Minimum freezing is one (1) month and maximum is three (3) months per annum.
*Monthly payments required by the membership agreement must be current before freeze time will take
effect.
*The Management reserves the right to unfreeze a membership, at any time, should the member's
account become past due.
*Membership freeze request approval is upon the Management discretion.

Member's Full Name: _____________________________________________

Membership Code: _____________________
Mobile Number: _____________________
Membership Type: _____________________
Last Date of Usage: _____________________

I request that the term of my membership be extended for a period of _________ (month/s)
because I will be unable to use the facilities beginning on _____________________ (effective freeze date)
through _______________ (last day of freeze) for the following reason:

_______________________________________________________________________________________

I have read and agreed to this written statement between the Management and myself.

Member's Signature: _________________________________ Fee: __________________________

Received by: ________________________________________

Approved by: ________________________________________ Date: _________________________

Proceed by: _________________________________________ Date: _________________________