PCF Fitness Membership Change Request

Please fill out the following form* to change an existing membership from one level to another** with Patriot & Potomac CrossFit.

*All data and information provided through this form is secured with an SSL certificate through Formsite.

** Levels include: 9x, 13x, and Unlimited

Member Information

First Name *

Last Name *

Email Address *

Is this for you or for someone else? *

Myself

Someone else

If Someone Else...

If Someone Else, Their Gender...

If Someone Else...

If you would like to change your payment method from Credit Card* to ACH, please fill out the following section.

*Credit card membership transactions incur a 5% processing fee.

Bank/Financial Institution

Routing Number

Account Number

Address

Address 2

City

State

Postal Code

Classes/Month *

# Months *

Members who joined prior to August 2013, please email info@pcf.fit to change your membership.

I agree to the terms and conditions. *

Yes.