Membership Cancellation Form

Cancellation Policy
1. Memberships are non-refundable unless cancelled within three days of purchase.
2. Cancellation during the initial one year contact will be permitted after payment of a $75 early termination/cancellation fee and completion of this form. After the initial year contact has been completed no fee will be required.
3. Monthly deductions will continue past the 12th month unless Campus Recreation receives a cancellation form by the 15th of the month prior to the desired cancellation month (ex: submit form by Jan. 15 to not be charged for February). If still under contract, cancellation will not be processed until the cancellation fee is received.
Today's Date

MonthDayYear
Membership Information
Full Name*

First NameLast Name
Email*
Member Number or M#*
Phone Number*

Area CodePhone Number
Desired Date of Cancellation (Final Bill Month)*

MonthDayYear
• If before the 15th of the month - the end of this month.
• If after the 15th of the month - the end of the next billing month.
Please tell us why you are considering cancelling.
Choose (1) one that applies:*

I am unsatisfied with the facilities (specify below)I am unsatisfied with the programs and services (specify below)I became a UC student (non-tuition remission)I don't have enough time to come into the Rec CenterI have left UC employmentI have relocatedI joined another gymMy medical condition prevents me from working outThe cost of membershipLack of reciprocity parking for UC employeesOther (specify below)
Specify any additional comments here:
Please rate your overall Campus Recreation experience*
Please rate the friendliness/helpfulness of Campus Recreation staff members*
Please tell us more about your membership experience. Is there anything we could do or provide to improve Campus Recreation?
Please note that all cancellations will be confirmed via email; if you do not receive an email within 10 business days, please contact the Member Services representative, Campus Rec.
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