Membership Cancellation Form

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Today’s Date:(*)

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First name:(*)

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Middle Inital(*)

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Last Name(*)

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Address

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Phone Number (Between 8am – 5pm):(*)

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Email Address::(*)

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Please indicate which members you are requesting to cancel:

Preferred Name:

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Preferred Name:

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Preferred Name:

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Preferred Name:

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Preferred Name:

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Preferred Name:

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Membership Type:

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Membership Type:

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Membership Type

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Membership Type:

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Do you have a locker?(*)

Yes

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Locker Number:

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3. On a scale of 1-5 (1 being poor and 5 being excellent), how would you rate URec’s customer service? Rating:

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4. On a scale of 1-5 (1 being poor and 5 being excellent), how would you rate URec’s facility overall? Rating: _______

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After the duration of your contract is complete, all membership may be terminated at no extra cost. Please complete this form by signing the bottom portion. Any questions can be sent to recmember@uab.edu. If you do not hear back from us within 2 business days, please follow up with the Membership Services Desk to see if we have received your form by calling 205-934-8224.

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By selecting this box, I am stating that I acknowledge the below as my official signature and I agree to UAB University Recreation Policies and Procedures in full.

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Type Name:(*)

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I agree to the above Rules and Regulations(*)

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