Membership Cancellation Form

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Membership Cancellation Form

Monthly membership cancellations require completion of a cancellation form at least seven business days prior to the next auto payment date in order to stop the payment from being processed. All memberships listed on the cancellation form shall be set for non-renewal for the next billing date but may continue to be used up through the date already purchased. Prorated refunds are not issued for monthly memberships.

I am requesting a cancellation for:*

Myself only. All memberships in my household. Someone else whose membership I have authorization to manage.

Name of Person Completing This Form*

First Name

Last Name

Name on Membership to Be Cancelled*

First Name

Last Name

Email*

Phone Number*

What type of membership are you cancelling?*

You have chosen to cancel a household membership. This will cancel ALL memberships within the household.*

I would like to cancel ALL memberships within the household. I would only like to remove myself from the household membership.

Please select all statements that apply to your Covid concerns.

I do not feel comfortable being in a gym due to Covid. I feel the MCC has too many Covid restrictions. I feel the MCC does not have enough Covid restrictions. The MCC is too crowded during Covid.

Other:

What equipment were you looking for?

What facility are you joining?*

Please list the facility you are joining.

Why aren’t you utilizing your membership? (select all that apply)*

I am too busy. I forgot I had a membership. I am not comfortable due to Covid. I am no longer motivated to work out. I was hoping for more member benefits. The MCC does not offer the equipment or activity I am interested in.

What types of member benefits were you hoping for?

What equipment or activities are you interested in?

What could we have done to improve your experience?

Do you have a rental locker?*

Yes No

Is there anything else you would like to share with the Monon Community Center team?

Please initial below to authorize your membership cancellation.*

Submission Review & Cancel Confirmation

Staff responsible for verifying that auto-billing has been turned off:*