Request for Membership TERMINATION OF EFT MEMBERSHIP

REQUEST FOR TERMINATION OF EFT MEMBERSHIP

*A 30 Day Notice is Required to Cancel a Membership
MEMBER NAME *

First Name Middle Name Last Name
MEMBER #
ADDRESS *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
PHONE NUMBER *
To help ensure future quality at the Becker Community Center, please answer the following questions:
1. Which of the following best describes your reason for leaving the BCC?

Financial reasons Joined another fitness center Medical Reasons Relocating Not enough time/too busy Dissatisfied Other, Specify
2. What did you LIKE most about your membership?
3. What did you DISLIKE about your membership?
4. What was the #1 reason you joined the BCC?
5. How likely are you to rejoin the BCC?
6. Do you have any suggestions to help us improve our facility and/or programs?

Please rate each category below:

By signing below I understand that if I have not been able to fulfill my one year commitment, I will be charged the $50.00 cancellation fee.
Member Signature *

Clear
Today's Date *

Month Day Year
Date
Thank you for being a member. We hope you return to the BCC soon!
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REQUEST FOR TERMINATION OF EFT MEMBERSHIP