Tertiary Email Address
Membership Change Request
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Name
Email
Phone Number
Sms Opt-In
By opting in to SMS, the Person agrees to receive announcements and billing alerts from Maozinha Brazilian Jiu Jitsu.
Standard messaging rates may apply. Messaging cadence may vary. Reply STOP to opt out.
Change Request (Reactivate, Freeze, or Terminate)
Date for Change Request to take place
Additional Comments
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