Alpert JCC Cancellation Form (2026+)

Alpert JCC 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.Format: (000) 000-0000.
Address

Street Address

Apartment / Unit #

CityState

Zip Code
Email
example@example.com

Do you plan to return at some time in the next year?
Could you please tell us what you liked about your time at the Alpert JCC?
If you would like to give us any further feedback, would you please detail why you are terminating your membership with us?
Please rate your time and experience with us as a member!

1-star Very Dissatisfied; 5-star: Very satisfied
Unit ID:__________ Staff Name:__________

Final Billing Date:__________ Final Date of Membership:__________

Date of Change:__________ Method of Communication: In-person / Mail
Should be Empty:

Alpert JCC Membership Cancellation Form