Club Fit | Membership Insurance and Flex Spending Reimbursement Request

Membership Insurance and Flex Spending Reimbursement Request

Members can request Insurance or Flex Spending Reimbursement for their membership. Please fill out the form below.

*Required Fields

First Name*

Last Name*

Club Location*

Briarcliff

Jefferson Valley

Phone Number*

Email Address*

Confirm Email Address*

Which do you need provided for your refund?* Check-Ins Total Cost

Dates you are requesting to for Reimbursement (Please use this format: mm/dd/yy)*

Start Date (mm/dd/yy)*

End Date (mm/dd/yy)*

Comments?

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