Membership Cancellation Request

Membership Cancellation Request
Because we use a third-party billing agency, we are unable to halt billing within 10 days prior to the next billing period. In order to stop your billing prior to the next billing month, we must receive notice no later than the last day of the month prior.

Example: To cancel your membership before the billing on December 10th, we must receive your request no later than November 30th. This allows us to stop the billing prior to the billing company locking in the next payment.
This form is a request form to cancel an entire membership only. To drop a member from your membership, please visit the membership office for assistance.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Daytime Phone*

Area CodePhone Number
Please check your reason for leaving the club:*

Moving/TransferredFinancialDon’t use club/Lost InterestUnhappy with facilityMedicalJoined another gym/club
Comments/Suggestions
Hockessin Athletic Club help me to reach my fitness goals:*

Strongly AgreeSomewhat AgreeSomewhat DisagreeStrongly Disagree
I am satisfied with the service I received at Hockessin Athletic Club:*

Strongly AgreeSomewhat AgreeSomewhat DisagreeStrongly Disagree
I am likely to return to Hockessin Athletic Club inthe future:*

Strongly AgreeSomewhat AgreeSomewhat DisagreeStrongly Disagree
I could be persuaded to remain a member of Hockessin Athletic Club:*

Strongly AgreeSomewhat AgreeSomewhat DisagreeStrongly Disagree
I understand and agree to the termination process outlined above
Signature

Clear
Should be Empty: