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2. Membership Change / Cancellation Request Form
4. Name on Account or Barcode Number*
5. Mailing Address*
7. Phone Number*
8. Email Address*
10. Membership Request Type
    -- Select One --Membership Cancellation RequestMembership Change Request

    Select from the list below
12. Reason for Change or Cancellation *
14. Effective Date for Request*
    Requests for cancellation of membership prior to the minimum 12-month commitment must be made in writing and directed to the Facility Specialist by the 15th of the month. There is a $100 early termination fee for cancelling your membership before the 12-month commitment is met. If the request is made after the 15th of the month, the member will be billed for the following month.
    
    Once the 12-month commitment has been met, the member may cancel without incurring the $100 early termination fee. If the request is made after the 15th of the month, the member will be billed for the following month.
    
    Residency status changes and membership type downgrades are not permitted once the membership has been purchased.
    
    Memberships are non-transferable.
    
    If a continuous monthly membership has been cancelled, the $60 activation fee will be applied to reactivate the membership if more than 30 days have lapsed.
16. Early Cancellation Fee*
    -- Select One --Yes, I am aware of the $100 FeeI have completed the 12 month agreement

    I am aware the $100 early termination fee will be assessed, if deactivating a membership prior to the 12 month anniversary. 

18. Initial*
    I have read and agree to the membership cancellation terms and conditions outlined above.
20. An email will be sent to confirm your cancellation request has been received and processed.
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field