BIRC Membership Change Form

BAINBRIDGE ISLAND RECREATION CENTER
Change Request Form
Name*
Full Name
Member ID
Email Address*
Mobile Phone*
Type of Change Requested*

Upgrade Membership TypeDowngrade Membership TypeStart Freeze (3 month minimum & 1/3 monthly dues)End FreezeEnd Membership (A 30-day notice to cancel is required for all cancelations. No pro-rate mid-month cancelations.)
*

I understand that I will be paying 1/3 of my monthly dues while my account is in Freeze status.
*

I agree that effective date of cancelation must be 30 days from today and that I could be charged for next month's dues. No pro-rate mid-month cancelation.
A 30-day notice to cancel your membership is required. No pro-rate for mid-month cancelations.

30-Day Notice Examples:

Cancel Jan 1 – Membership would end Jan 31 (30-day notice puts cancelation date to the end of Janaury and prior to the billing for February)

Cancel Jan 5-Jan 31– Membership would end February 28 (30-day notice puts cancelation date past the billing for February so they pay for the full month of January).
Desired Date of Change, Freeze or Cancelation (30-day notice required to cancel.)

MonthDayYear
Date
Reason*
Residency Status:
Current Membership Type:
Change Membership Type TO:
Add Family Member(s)
Remove Family Member(s)
Add/Remove Family Member*
Reason (Other)*
Please share with us why you are teminating your membership and what we can do better - thank you!
Should be Empty:

BAINBRIDGE ISLAND RECREATION CENTER