Registration Cancellation Form

Use this form only if:

you are cancelling out of the class that is billed monthly.
you are past the cancellation date for the program.

Cancellation Policy: A member account will be billed the full program fee unless a registration is officially cancelled atleast 5 days in advance of the program start date.

Enter member information who is registered in the program

Member Account # (full 5 digits) *

E-mail Address *

First Name *

Last Name *

Birthdate *

Phone Res# *

Phone Bus# *

Department *

Full Class Name & Level *

Program Start Date *

Day *

Time *

Reason *

By submitting this form I acknowledge that I am past the cancellation date for this class and may be billed the full program fee. Please allow 72 hours for processing.

Submit