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Auto Pay Membership Cancellation Request

2. 

4. Cancellation forms received 48 hours in advance of the next billing date of your membership will terminate and your card/ETF will not be charged again. If the cancellation request is submitted after the 48 hour window, your account will be billed for the following month. The DRC does not refund for transactions already completed.

6. First Name*

7. Last Name*

8. Today's Date*
   Today's Date

10. Address*

12. City*

13. State*

14. Zip*

16. Phone*

17. Email*

19. Membership Package*
    -- Select One --FamilyAdult/YouthKids Club

21. Reason for canceling membership

    1. Schedule Conflict
    2. Budget
    3. Joined another Facility
    4. Moving
    5. Medical
    6. Seasonal Membership
    7. Other (please comment below)

22. Would you rejoin the DRC?

    1. Yes
    2. No

24. What did you like about your DRC membership?

26. What would you change about your DRC experience?

28. Internal Use:

    1. Date
    2. Staff

    1. Task
    2. Filed

29. Original Receipt Number

Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field