WRC Membership Payroll Deduction Cancellation Form

Please only complete this form if you are participating in payroll deduction. If you would like a refund for a membership, please complete the separate refund request form.

Name Name * First Last
Panther ID *
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Phone Phone * - ### - ### ####
Reason for Cancellation: *
Cancellation Policy:

Cancellation of membership may take more than 14 days to be finalized. Cancellation of a gold membership cannot be processed until locker is cleaned out and laundry bag is returned. Locks are WRC property and must remain on the locker. A confirmation e-mail will be sent after cancellation form has been
received.
Type of Membership *

Type of Membership Payroll Deduction Blue Payroll Deduction Gold Payroll Deduction Silver Monthly Membership Semester Membership Annual Membership
Locker Number (for Gold Memberships)
Add-on Member Cancellation

If you are also cancelling a membership for an add-on member to your membership, please fill out this area.
Name Name First Last
Panther ID
Email
Phone Phone - ### - ### ####
It is essential that we understand what members expect from our facility. As someone who does not intend to renew their membership, please take a couple of minutes to complete our short exit survey.
1. What caused you to cancel your membership? *

1. What caused you to cancel your membership? Change in role or career and no longer involved at FIU Unable to actively participate Retiring Relocation Medical reason Enrollment in other fitness facility Time constraints Locker availability Lack of programs offered Other (Please specify) Other (Please specify)
Are there any program(s) would you have enjoyed, but we did not offer?
2. What would make you more likely to continue your membership? *

2. What would make you more likely to continue your membership? Offer a specific program Expand the facility hours of operation Parking Locker availability Offer additional classes There is nothing that would allow me to continue my membership at this time

WRC Membership Payroll Deduction Cancellation Form

WRC Membership Payroll Deduction Cancellation Form

Cancellation Policy:

Add-on Member Cancellation