BIRC Membership Change Form

BAINBRIDGE ISLAND RECREATION CENTER
Membership Change Request Form
Name*
Full Name
Member ID
Email Address*
Mobile Phone*
Today's Date

MonthDayYear
Date
Type of Change Requested*

Upgrade Membership TypeDowngrade Membership TypeCancel Membership (A 30-day notice to end membership is required for all cancelations. There is no proration of dues for early cancelations.)Freeze (Pause your membership for at least 3 months. Members will be charged 50% of membership dues during paused months.)
I agree that effective date of my cancelation must be at least 30 days from the date I am submitting this form. That I will be charged for the full amount of my next month's membership dues regardless of services being rendered if the 30 days takes me into the next month.
Per your signed membership agreement, a 30-day notice to cancel your membership is required.

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 member will also pay for the full month of February).
Desired Cancelation Date (Must be at least 30 days from the date this form is being filled out.)

MonthDayYear
Date
Desired Freeze Start*

MonthDayYear
Start Date
Desired Freeze End Date*

MonthDayYear
End Date
Do you want all members on this agreement terminated?   Yes   No*
If not, please specify which member(s) will continue.
First Name   Last Name
First Name   Last Name
First Name   Last Name
First Name   Last Name
First Name   Last Name
Please note that if the Head of Household for your agreement is leaving the membership, a credit card for the remaining member(s) will need to be provided.
Reason*
Residency Status:
Current Membership Type:
Change Membership Type TO:
Add Family Member(s)
Remove Family Member(s)
Add/Remove Family Member*
Notes:
Should be Empty:

BAINBRIDGE ISLAND RECREATION CENTER

Membership Change Request Form