Change Form

AUTHORIZATION*
I Accept
I am the 'Primary Member" listed on my Membership Agreement and I am authorized to make a change or changes to the Membership Agreement. I am requesting that my account is updated and modified as outlined in the Change Form. Nothing will be modified to the original Membership Agreement except those modifications requested and approved by VERDURE. I understand that there are specific fees and conditions required to follow and pay in order for modifications of any kind to be approved. Furthermore, I understand that my request my be denied if they do not meet the requirements and definitions outlined in my Membership Agreement or VERDURE's Rules and Regulations. If my request is denied, I will be notified by VERDURE and provided the reasons. Otherwise, if accepted, there will be no further notification and the changes will be reflected in the next billing cycle provided I have given sufficient notice.

Membership Definitions:
A Single Membership is designated to a single individual.
A Couple Membership is designated to two individuals cohabitating and being billed to one account, and proof of co-habitation satisfactory to Club may be required for eligibility.
A Family Membership is designated to married couples, or a single parent with children under the age of 23 years, who reside in the same home and being billed to one account. Proof of co-habitation or proof of residency and/or familial relationship satisfactory to Club may be required for eligibility. Dependent children who are members under a Family Membership must upgrade to the prevailing single member rate upon their 23rd birthday. The enrollment of dependent children requires the signature of a parent or legal guardian on the Membership Agreement.
Non-immediate children that reside in the same household must provide a Texas Authorization Agreement for Nonparent Relative or Voluntary Caregiver Form. There will be a $35/ month dues add-on charge for each individual. If the child does not reside in the same household, they are not allowed to be added-on.
Nannies that assist with children of the Primary Member and that are a minimum of 18 years old and are present with the children they are supervising at all times can be added-on for $35/month. In the event a Nannie wants to use the facilities without the children, they will need to purchase an Single Membership.

Name*
First Last
Date of Birth*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Phone*
Email*

IMMEDIATE OR NON-IMMEDIATE FAMILY?
ADD OR REMOVE?
- Add
- Remove
ADD OR REMOVE?
- Add
- Remove
ALL ADDS
ADD IMMEDIATE FAMILY
ADD NON-IMMEDIATE FAMILY
NAME
First Last
BIRTH DATE
GENDER
- M
- F
ALL SUBTRACTS
REMOVE IMMEDIATE FAMILY
REMOVE NON-IMMEDIATE FAMILY
NAME
First Last
BIRTH DATE
Date Format: MM slash DD slash YYYY
GENDER
- M
- F

ARE THERE ANY MORE CHANGES NEEDED?
- YES
- NO

CHANGE THE FOLLOWING
CREDIT CARD NUMBER
DATE OF EXPIRATION
PLEASE ENTER IN MM/YYYY FORMAT
SECURITY CODE
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Change From*
Change To*
PLEASE EXPLAIN YOUR MEMBERSHIP CHANGE

ARE THERE ANY MORE CHANGES NEEDED?
- YES
- NO

CHANGE THE FOLLOWING
CREDIT CARD NUMBER
DATE OF EXPIRATION
PLEASE ENTER IN MM/YYYY FORMAT
SECURITY CODE
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Change From*
Change To*
PLEASE EXPLAIN YOUR MEMBERSHIP CHANGE

ARE THERE ANY MORE CHANGES NEEDED?
- YES
- NO

CHANGE THE FOLLOWING
CREDIT CARD NUMBER
DATE OF EXPIRATION
PLEASE ENTER IN MM/YYYY FORMAT
SECURITY CODE
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Change From*
Change To*
PLEASE EXPLAIN YOUR MEMBERSHIP CHANGE

AUTHORIZATION
I AGREE THAT*
I authorize and approve the above changes. I also understand and agree that in the case of a down grade these changes will not be effective until 30 days from the next full billing cycle. In case of a membership upgrade, the change will be effective immediately. A processing fee of $29 may be charged for a membership status change.
CAPTCHA

Step 1 of 13

ADD/REMOVE HOUSEHOLD MEMBERS

ADD IMMEDIATE____BACKEND

REMOVE IMMEDIATE____BACKEND

ADD NON- IMMEDIATE____BACKEND

Remove Non-immediate family

ADD IMMEDIATE____BACKEND2

REMOVE IMMEDIATE____BACKEND

ALL ADDS

ALL SUBTRACT

ALL ADDS

ALL SUBTRACTS

AUTHORIZATION

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