Nexus Jiu-Jitsu & MMA ,
Membership Pause/Cancellation Request Form

Please complete this form if you wish to pause or cancel your membership. We kindly ask that all sections be filled out clearly to ensure smooth processing.

Name *

Email *

Phone Number *

Select One Option: *

Pause Membership

Cancel Membership

If Pausing Membership

Pause From (Start Date): *

Pause Until (End Date): *

If Cancelling Membership

Final Payment Date: *

(1 month's notice applies—see policy below)

Reason for Pause or Cancellation:

Hold & Cancellation Policy

Hold Policy

You may pause your membership up to 3 times per calendar year.
hold can last up to 6 weeks.
A minimum of 7 days' notice is required before your next scheduled debit.
A $20 account holding fee applies for each hold.

Cancellation Policy

1 month's notice is required to cancel your membership.
A $20 cancellation fee applies to cover administrative processing.
Cancellations must be submitted using this official form.

I have read and agree to the Hold Policy & Cancellation Policy Above.

Signature *

Date *