2024 Pulse Generator Membership Cancellation Form

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Please note Annual Memberships are non refundable and non transferable. Please ensure that you provide all of the information in order to complete your cancellation in a timely manner. Failure to provide details, may result in a delayed cancellation.

*** Memberships cancelled within the first year are subject to an additional month payment of $25.00***

Email *

Please Cancel *

Membership

Locker

Both

Location *

University of Alberta Hospital

Royal Alexandra Hospital

Grey Nuns

Misericordia

Glenrose

Sturgeon

Edmonton - EMS

Foothills Medical Centre

Rockyview General Hospital

Peter Lougheed

Alberta Children's Hospital

Southport Tower

Stonegate EMS

First Name *

Last Name *

Employee Number *

Swipe Card Number *

Please Fill Out *

AHS

COV

APL

Other:

Please check your membership type: *

Payroll Deduction

Credit Card

Annual Membership

Required

Reason For Cancellation

A copy of your responses will be emailed to the address you provided.

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