Cancellation Request Form
Must be received by 20th day of current month to avoid next month's dues.

Only one (1) form submission required per account.  All members on account will be cancelled.
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Name(s) on Account *
Only one (1) form submission required per account.  All members on account will be cancelled.
Member # *
Found on your Membership card.
Address *
City *
ZIP *
Phone *
Email address *
For confirmation purposes only.
Effective Date: *
Reason for Cancellation *
Please help us to improve our service by indicating the reason you are cancelling the membership. If you have staff or facility related concerns, we would greatly appreciate learning them:
Required
Comments
Cancellation Terms
I/We intend to cancel my/our MJCC membership as of the end of this month.  I/we understand that at that time I/we will no longer be eligible to use the MJCC facilities.  I/We am also responsible for all membership fees and charges on my account through the cancellation date.  I/We also understand that by terminating my/our membership, I/we am forfeiting any and all fees paid to join the MJCC and will be subject to the prevailing membership policies and rates, including all fees, if I/we decided to rejoin at a later date.  I/We also understand that if I/we rejoin at a later date the membership priority date will begin a new period as of the date I rejoin. *
If the date is after the 20th of the month, I/we understand that cancellation will be effective as of the last day of the next month. *
By clicking "Submit" your cancellation request will be processed.  You will receive a confirmation email once you submit this form, and then an additional confirmation email once your request has been processed.
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