Put Account on Hold Form without Pay Location*SelectMontgomery, AlabamaTallahassee, Florida - KillearnTallahassee, Florida - Killearn LakesTallahassee, Florida - Park AvenueWestchase, FloridaWeston-East, FloridaWeston, FloridaName*Phone*Email* Member has met contract requirements but would like to continue as a member once returned. I, understand that by checking the above section that BodyTrac Health and Fitness will not charge me during the time stated above. If a member terminates during hold time they will have one more payment.ReasonFrom - Date (mm/dd/yyyy)*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920To - Date (mm/dd/yyyy)*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Member Electronic Signature (agree)* Check to Confirm Date*
