Beckerman Recreation Center - Membership Cancellation Form

Request Form for current Beckerman Recreation Center members to cancel their membership or locker.

Please visit http://www.newhaven.edu/student-life/health-wellness/chargerrec/membership.php for our Membership Cancellation Policy.

Your Information

Member Name Member Name First Last

Member Email

I would like to cancel:

I would like to cancel: My membership (and locker, if applicable) Just my locker

Membership Cancellation Information

*Please note: Upfront 1, 4, and 12 month memberships will terminate on their expiration date. Members wishing to terminate their membership before their expiration date must receive written approval from the Director of Campus Recreation.

Membership Type

Membership Type Alumni - Credit Card Repetitive Repetitive - Credit Card Repetitive Faculty/Staff - Credit Card Repetitive Faculty/Staff - Payroll Deduction Household - Credit Card Repetitive

Reason for Cancellation (check all that apply)

Reason for Cancellation (check all that apply) Do not regularly use the facility Joined a different fitness/recreation facility Facility does not meet my needs Other

Do you also rent a locker?

Do you also rent a locker? Yes No

Locker Cancellation Information

*Upon submittal of this form, all belongings must be removed from locker by the end of the day.

Locker Location

Locker Location Men's Locker Room Women's Locker Room

Locker Number

Reason for Cancellation (check all that apply)

Reason for Cancellation (check all that apply) Do not use locker Cancelled membership Other

Confirm Cancellation

Please draw your signature here to signal your intent to submit this cancellation. Upon submitting this form, you will receive an email with the information you submitted.

Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
To Be Completed by ChargerREC Staff
Received by
Date
Membership Cancelled in CSI Date

Beckerman Recreation Center - Membership Cancellation Form