Cancellation Form

Cancellation Form
This electronic version of a cancellation form must be submitted 5 business days prior to the month in which you want to cancel your membership. Please refer to our cancellation policies for more information. Please allow 2 weeks to receive an e-mail confirmation.
Main Member Name*
First Last
Member ID #*
Number on your Key Tag or Moraine ID
Email Address*
Phone*
Payroll Deduction?*
- Yes
- No
Do you currently have a locker rental?*
- Yes
- No
Are you the only member on the account being cancelled?*
- Yes
- No

Additional Cancellations
Please indicate additional members/services that you would like to cancel
#1 - Member ID
#1 - Name
First Last
Please cancel the following for Member #1:
Highlight all that apply
#2 - Member ID
#2 - Name
First Last
Please cancel the following for Member #2:
Highlight all that apply
#3 - Member ID
#3 - Name
First Last
Please cancel the following for Member #3:
Highlight all that apply
#4 - Member ID
#4 - Name
First Last
Please cancel the following for Member #4:
Highlight all that apply
#5 - Member ID
#5 - Name
First Last
Please cancel the following for Member #5:
Highlight all that apply
#6 - Member ID
#6 - Name
First Last
Please cancel the following for Member #6:
Highlight all that apply
Please list Member ID, name, and services you wish to cancel of any members not listed above.

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