MEMBER CANCELLATION

MEMBER CANCELLATION REQUEST

We're sorry to see you go, but we understand that plans change. Please complete the member cancellation request form below and submit it at your earliest convenience to begin the process. If you have any questions in the meantime, please call 757-369-2876.

Name

First Name

Last Name

Member Number

Phone

(###)

###

####

Cancellation Request Date

Please choose a date on which you would like your membership to be canceled.

YYYY

Reason for Canceling

Cancellation Request

I hereby request the cancellation of my membership at Hampton Virginia Aquaplex. I understand that I am required to provide a minimum of 30 days’ notice prior to the cancellation date.

YES

Acknowledgement

I acknowledge that by submitting this form, my membership at Hampton Virginia Aquaplex will be terminated as of the cancellation date specified above. I understand that I will no longer have access to the facilities and services offered by Hampton Virginia Aquaplex after the cancellation date.

YES