Membership Cancellation Form
All Cancellations must be submitted prior to the 19th of the month to avoid any additional drafts. Your membership term is one year. If you have not yet completed your one year term but you are moving outside of a 50 mile radius, joining the military or have a medical condition that doesn't allow you to utilize the facility, please contact Abigail Dowling at adowling@pleasantprairiewi.gov and provide documentation supporting your early termination request and pay the $50 termination fee. If you have not completed your one year term, you will be unable to submit this form. You will receive a confirmation email once your cancellation is processed.
Main Member Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Is there anything we can do to keep you as a member?
*
Please choose one of the following
*
I am beyond my 12 month commitment
Early termination - Must have manager approval
What is your reason for cancelling?
*
Did you join during a membership special?
*
Yes
No
If yes, what?
*
Proof of move, medical or other documentation attached
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Signature of Main Member
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: