Membership Termination Form
Submission of this form is a formal request to end your membership agreement for your recurring monthly membership with Old Dominion University Recreation & Wellness. For members on credit/debit card auto-draft, the termination form must be submitted at least five business days before the end of the month or another auto-draft will occur on the first business day of the month. All credit/debit card auto-draft memberships terminate on the last day of the month. For members with a payroll deduction membership, the termination form must be submitted by the 10th or the 25th of each month. Termination forms submitted by the 10th of the month will incur one more payroll deduction on the 16th of the month, and the membership will terminate on the last day of the month. Termination forms submitted by the 25th of the month will incur one more payroll deduction on the 1st of the month, and membership will terminate on the 15th of the month.
I am currently paying my membership through:
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Auto Draft
Payroll Deduction
Primary Member Name
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First and last name
Member UIN or Barcode
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Member Email Address
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Please select reason(s) for termination:
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Dissatisfied
Financial burden
Not using the facility
Relocation
Using another facility
Enrolled as an ODU student
Medical/ Illness
Parking
Other
Please explain reason(s) for termination:
Signature
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Submit
Should be Empty: