Freeze Request Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Freeze Request Form

Must be received by 20th day of current month to avoid next month's dues.

• Administration Fee: $15 per month.
• One (1) month minimum. Six (6) month maximum.
• Must continue to fulfill the 12 month agreement* (for annual commitment membership only).
• Freezes begin on the first day of each month and will end on the last day of the month.
• Only one (1) form submission required per account. All members on account will be frozen.

Name(s) on Account *

Only one (1) form submission required per account. All members on account will be frozen.

Member # *

Found on your Membership card.

Address *

City *

ZIP *

Phone *

Email address *

For confirmation purposes only.

Do you want to start a Freeze, or end your existing Freeze early? *

Start Freeze

End Freeze Early - Can be submitted at any time during the month. Your account will be prorated for the remaining days.

Clear form

Never submit passwords through Google Forms.

This form was created inside of Portland Jewish Academy. Report Abuse

Forms