Member Cancellation Form

To cancel your membership at the Aztec Recreation Center, please complete the form below. You will recieve a confirmation e-mail after the form has been submitted.

Please do not reply to the confirmation email.

* Indicates required field.

22 Nov 2009 21:26 PM

* Last Name:

Hand Code:

Apt.:

* Zip:

* State:

* First Name:

* Student ID:

* Address:

* City:

* E-mail:

* Evening Phone:

* Daytime Phone:

Locker #: "I understand that my locker cancels automatically and I have removed all of my belongings."

* Status:

* We appreciate your business and would like to know how to improve our services. Please provide the primary reason for discontinuing your membership:

If you have any additional questions or comments, please let us know:

*	1. "At the time of registration, I agreed to a four-month minimum. If I have not met the minimum, I will pay any remaining fees at the time of cancellation. I also understand that I am responsible for payment of any past due balances."
*	2. "By maintaining my current membership, my rates are guaranteed. I understand that if I reinstate my membership at a later date, my rates will be increased to the current monthly dues."
*	3. "I understand it is my responsibility to ensure that all billing has stopped. I will retain my copy of this Membership Cancellation form as my receipt and contact the Aztec Recreation Center within 60 days to promptly resolve billing problems."
*	4. "I understand this form must be received before 12pm on the 24th of the month to avoid further billing."

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Last update: 7/7/09