Membership Information

Primary Contact: *

Home Phone: *

E-mail address: *

Mailing Address: *

City:

Postal Code: *

Family members to cancel

Name:

Type of membership: Choose Option Adult Youth Child Senior Family

Date of Birth: ...

Name:

Type of membership: Choose Option Adult Youth Child Senior Family

Date of Birth: ...

Name:

Type of membership: Choose Option Adult Youth Child Senior Family

Date of Birth: ...

Name:

Type of membership: Choose Option Adult Youth Child Senior Family

Date of Birth: ...

Name:

Type of membership: Choose Option Adult Youth Child Senior Family

Date of Birth: ...

Name:

Type of membership: Choose Option Adult Youth Child Senior Family

Date of Birth: ...

Reasons for cancellation

Reasons for cancellation: Choose Option Too busy Not enough lockers Too far away Unsatisfied with equipment Seasonal Too expensive Moving, not using Can't use equipment Not what I expected Personal Other

If "Other" explain why:

A copy of this form will be e-mailed to you. Please retain it for your files. In the case that the primary contact (1st adult) wishes to cancel, all remaining members will be charged accordingly, meaning that the remaining adults will be moved up to 1st adult, and 2nd adult.Servus Credit Union Place's annual monthly memberships shall renew, automatically unless cancelled by the member at least 3 business days prior to the end of the membership term.