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Membership Cancellation Form
Membership Cancellation Form
*** Please note: Members requesting cancellation of a Membership Agreement, must meet the following criteria:
Must have completed the one (1) year contract period or;
Have a qualifying reason for cancellation as outlined in the
Membership Handbook
.
Minimal of 30-day notification is required.
Account Information
Last Name
First Name
Phone Number
Email Address
Street Address City and Zip Code
Effective Date
Membership Information
Individual or Family Membership
Individual
Family
Multiple Individuals
Senior
Membership Term
Monthly
Quarterly
Annual
Type of Membership
District (Community Center, Pools & Tennis)
Community Center
Residency
BCMUD Resident
Non-Resident
Cancellation Reason
Customer Signature
Date