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2. This form is for CHANGES only, if you would like to Cancel your membership, please complete a Request to Cancel Membership Form. --Changes are subject to manager approval and at the discretion of the Membership Team. --Any change to a membership type is subject to a new membership with increased fees and changes in structure. --Change requests will be reviewed on a case-by-case basis and may take up to 30 days for review. --Each change to a membership/pass may incur a $5 processing fee.
4. Please read the above statement.*

   1. I have read, understand and agree to the change policies.
6. Name*
8. Email*
9. Confirm Email*
11. Street Address*
13. City*
14. State*
15. Zip Code*
17. Primary Phone Number*
21. Current Membership
22. Membership Expiration Date
24. Membership Type Change
    A member of the Membership Team will contact you by email, regarding this change.
26. Add or Remove Member
    -- Select One --AddRemove
27. Full Name
28. Date of Birth
29. Gender
31. Add or Remove Member
    -- Select One --AddRemove
32. Full Name
33. Date of Birth
34. Gender
36. Add or Remove Member
    -- Select One --AddRemove
37. Full Name
38. Date of Birth
39. Gender
41. Add or Remove Member
    -- Select One --AddRemove
42. Full Name
43. Date of Birth
44. Gender
46. Updating Payment Information:
    Please call the membership Team at 303.805.3275 to update payment information. If you go into your ACTIVE Net account to update, please email the Membership Team at membership@parkeronline.org to let them know the last 4 digits of the new card number.
48. Additional Notes About Change Request
50. Please read and acknowledge the following statement.*

    1. I acknowledge that by making changes to my membership, I may be required to complete a new membership and incur higher fees.
52. Customer Signature*
54. Change requests may take up to 30 days for review. Someone from the Membership Team will email you to confirm the change. If you have additional questions about memberships, please email membership@parkeronline.org or call 303.805.3275.
Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit Submit and Print

* indicates a required field