Membership Cancellation Request

Membership Cancellation Request

802-206-2850 | www.uvacswim.org
Primary Member Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Today's Date*

MonthDayYear
Today's Date
AnnualEFT
2-Parent1-ParentAdultYouthSenior
YesNo
If "No", list the names of those to be terminated
I hereby give written notice of termination. Per my membership contract, I understand that this notice of termination must be received by the 24th of the month prior to cancellation; and that I am responsible for all monthly fees through the last day of my membership. I understand that submitting this form does not guarantee cancellation, and that I will receive an email upon my cancellation request being approved OR denied.*

I acknowledge the above terms
Termination Date*

MonthDayYear
Termination Date
Reason for Termination*
We strive to meet the needs of our members and welcome your feedback. Do you have any suggestions that would have made your experience better?
Member Signature*

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PLEASE NOTE: REFUNDS AND/OR CREDIT CARD ADJUSTMENTS MUST BE DONE MONDAY THROUGH FRIDAY, BETWEEN 8:00AM AND 5:00PM.
HOURS
Mon–Fri: 5:00 AM – 7:30 PM
Saturday: 6:30 AM – 4:00 PM
Sunday: 7:30 AM – 3:00 PM
Pools close 15 minutes early

MAILING ADDRESS
Upper Valley Aquatic Center
PO Box 1198
White River Junction, VT 05001
Should be Empty: