Request to Change Membership "*" indicates required fields Member Name* Member First Name Member Last Name Phone*Email* Club Location where I enrolled** Everett Wallingford Columbia City Ballinger Village ECA Membership Type* Champions Amenities Unknown I am requesting to** Cancel my membership Cancellation Reason**Check all that apply. Moving Non-use Too expensive Staff Cleanliness Product Experience Other Other Reason* Notes for Management*I understand that this is a request for cancellation of the above-referenced ECA membership. I understand that I am liable for all payments that are currently due, past due, or those that will accrue during the thirty-day notice period before my cancellation of my membership will be processed. I understand an Emerald City Athletics representative will contact me via the information provided on this form submission to complete the cancellation of my current membership agreement, including the review of last bill date(s), club access availability, and any other questions or concerns I may have. Δ
