Club:

CANCELLATION
Title: Tel No:
Forename: E-mail:
Middle Initials:
Surname:
Address:

Postcode:

Reason for Cancellation:

Is there anything we could do to keep you?

Are you aware you can choose to freeze your membership instead?

TERMS AND CONDITIONS OF CANCELLATION

 You must abide by the cancellation notice period applicable to your membership
contract
 In the unlikely event of a dispute, it is the member’s responsibility to provide proof of cancellation
 You must keep your copy of this cancellation and be able to produce it if requested to confirm
your cancellation, if you are not offered a copy please request one
 Do not cancel your direct debit until all payments have been made after the submission of this
form, doing so could result in irreversible administration charges
 You may not downgrade your membership within the cancellation period
 You are able to withdraw your cancellation at any point during the cancellation period, we can
accept this withdrawal verbally and once it has been accepted you must resubmit a cancellation form to
cancel your membership
BY SIGNING THIS AGREEMENT I HEREBY STATE THAT I HAVE READ, UNDERSTOOD AND ACCEPT THE
TERMS AND CONDITIONS OF CANCELLATION

Signature:

Date:

Date Received: Actions:

Membership Number: Staff Name:

MANAGER SECTION MOST RECENT PAYMENT DATE: FINAL PAYMENT DATE: MANAGER SIGNATU