IMAA Cancellation Request Form

Membership Cancellation Request On-Line Form

* Indicates required field

Student Name *

First

Last

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Reason of Canceling *

Personal (Non-Medical) Reason

4 to 9 Months remaining in the agreement. Cancellation $499
10 and up Months remaining in the agreements. Cancellation $999

Relocation 25+ miles away from the academy

Multi-Style System or Kickboxing. Cancellation $199.99
Black Belt Member. Cancellation $ 299.99

Upload Proof of new address *

Max file size: 20MB

Cancelling for medical Reason

Upload Medical Certificate File Here: *

Max file size: 20MB

Multi-Style System or Kickboxing.

I have read the above Agreement, understand and agree with its terms. If the cancellation payment is not remitted, the agreement will be active and the collection company will continue to bill the account.

Today's Date *

Member Signature (or guardian under 18) *

Submit