AJCC Membership Cancellation Form

AJCC Membership Cancellation Form

CANCELLATION POLICY: Cancellations Require 30 days' notice once this form is completed and submitted; this is by calendar month, not date. *Please note all returning members pay the initiation fee when rejoining*
Name*

First NameLast Name
Birth Date*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Apartment / Unit #

CityState

Zip Code
Email*
example@example.com

We deeply regret and sincerely apologize if our Customer Service staff has not met your expectations or needs. If you feel comfortable, please tell us about your experience that made you cancel your membership. You do not need to provide specific names if you do not feel comfortable.

Optional: If you feel comfortable, would you be able to tell us a bit about what kind of health services/wellness accommodations we may have been able to provide to keep you with us as you navigate your medical/health conditions?

Do you plan to return at some time in the next year?

YesNoUnsure
If you would like to give us any further feedback, would you please detail why you are terminating your membership with us?
Should be Empty: