Des Moines Jiu-Jitsu Academy

Name *

First Name

Last Name

Address *

Address 1

Address 2

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Phone *

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Reason for cancelling?

We appreciate your business and would like to know how to improve our services. Please provide the primary reason for discontinuing or freezing your membership (check all that apply):

Moving

Joining another martial arts studio

Too costly

Poor service from staff

Lack of time to work out

Medical reasons

Classes overcrowded

Inadequate BJJ program

Inadequate Muay Thai program

Inadequate parking

Other

Freeze or Cancel *

Freezing: By maintaining a frozen membership, my rates are guaranteed and all registration fees will be waived. By submitting this form I understand the following. I understand that the frozen membership fee is $10/month on the standard billing cycle. I understand it is my responsibility to ensure that billing has changed to the frozen rate of $10/month and I will validate by emailing info@iowabjj.com to confirm receipt of the form. Please contact Des Moines Jiu-Jitsu Academy immediately if billing has not changed as it was intended. Cancelling: By maintaining my current membership, my rates are guaranteed. By submitting this form I understand the following. I understand that if I reinstate my membership at a later date, my rates will be increased to the current monthly dues and all current registration fees may be assessed. I understand it is my responsibility to ensure that all billing has stopped and I will validate by emailing info@iowabjj.com to confirm receipt of the form. Please contact Des Moines Jiu-Jitsu Academy immediately if billing has not ceased as it was intended.

Freeze (Keep existing rates $10/month)

Cancel (Lose all current pricing)

30 Day cancellation notice *

I understand that Des Moines Jiu-Jitsu Academy requires 30 days notice to freeze or cancel membership and that my account may be charged the monthly rate if today’s date falls within 30 days of the next billing cycle.

I agree