Membership Cancellation Form

Please provide us with the following details to cancel your MSAC Membership.

First name: *

Last name: *

Email: *

Member No: *

Length of membership: select...<1 year1-2 years2-3 years3-4 years4-5 years5-10 years10+ years

Reason for cancelling: * select...Moving out of areaMedical/injuryChanging MSAC membershipsPersonal financesLack of use/timeUnhappy with facilityLow value for moneyChanging gyms/facilitiesOther...

If other, please specify:

Cancellation date:

Effective Immediately: (please note your membership cancellation takes 30 days from submitting this form)

Specific Date: (must be at least 30 days from today)

If another date, please specify:

must be at least 30 days from today

Please rate the following aspects of your MSAC membership?:

	Excellent	Good	Average	Poor	Very poor
Equipment
Change room/facility
Staff
Fitness classes

Are you considering returning as an MSAC Member?:

Yes

Maybe

No

Communications:

I wish to discontinue receiving communications from MSAC.

Disclaimer: *

I understand and agree with the cancellation terms outlined in my membership terms and conditions and that my membership will only be classified as terminated once I receive a cancellation receipt number from MSAC Health & Wellness.