Freeze Request Form

Freezes must be submitted 1 week prior to start date.

By submitting this request, I understand that this request must be for a period of one, two, or three months and that I may freeze my account for a maximum of three months per year of membership. Any additional materials to support my request (e.g. doctor's note, etc) must be faxed to 212-717-0706.

All memberships freezes are subject to a $50 reactivation fee, unless taken for medical cause with proper documentation submitted.

Freezes are granted for Annual members only. Month to Month members may submit requests which are subject to New York Yoga manager's discretion.

* Required


First Name: *

Last Name: *

Email:*

Phone Number:*

Mailing Address: *

State:*

Start Date of Freeze: *

End Date of Freeze: *

Reason for freeze request : *