Direct Debit Membership - Cancellation Form

Complete the form below to cancel your direct debit membership.

Full Name: (required)

Email address: (required)

Student / Staff ID#:

Membership cancellation date (required)

Day Month Year

I am cancelling my membership because: (required)

I am leaving the University
I am joining another gym in Wellington
I am unsatisfied with the facilities
I am moving out of Wellington
I am suffering from financial hardship
Other (please specify):

Cancellation (required)

I understand that I am providing 7 days' notice of cancellation of my membership and that if there is a payment due within 3 days of the cancellation date, I am expected to pay. I understand that by cancelling my membership I will no longer have access to fitness facilities with University Recreation Wellington. I acknowledge that cancellation will also terminate the Direct Debit Authority held by Debitsuccess and if I decide to rejoin via Direct Debit I will need to pay the $15 joining fee again. By checking this box you agree with these terms.

Agree