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I understand that my sponsored spouse/companion will also be canceled. Spouse/companion name OR Please drop my spouse/companion only from my membership effective 30 days from the above date. I understand that if I choose to rejoin and continue with my exercise program within a year of my cancellation date I will be assessed a 50 rejoin fee. Method of payment How have you paid your dues please circle Payroll Deduction Bank Draft Check Credit Card Cash Reason for canceling please circle Facility too small Financial Inconvenient Joining another gym Leaving for Summer No usage Parking Scheduling Leaving School Terminated Other Signature --------------------------------------------------------------------------------For office use Staff initials Notes T FORM UAMS Fitness Ctr Cancellation Form 6-12. Date UAMS Fitness Center Membership Cancellation Form SAP/Student ID Phone Number Please cancel my UAMS Fitness Center membership effective 30 days from the above date. I understand that my sponsored spouse/companion will also be canceled* Spouse/companion name OR Please drop my spouse/companion only from my membership effective 30 days from the above date. I understand that if I choose to rejoin and continue with my exercise program within a year of my cancellation date I will be assessed a 50 rejoin fee. Method of payment How have you paid your dues please circle Payroll Deduction Bank Draft Check Credit Card Cash Reason for canceling please circle Facility too small Financial Inconvenient Joining another gym Leaving for Summer No usage Parking Scheduling Leaving School Terminated Other Signature --------------------------------------------------------------------------------For office use Staff initials Notes T FORM UAMS Fitness Ctr Cancellation Form 6-12. Date UAMS Fitness Center Membership Cancellation Form SAP/Student ID Phone Number Please cancel my UAMS Fitness Center membership effective 30 days from the above date. I understand that my sponsored spouse/companion will also be canceled* Spouse/companion name OR Please drop my spouse/companion only from my membership effective 30 days from the above date. I understand that my sponsored spouse/companion will also be canceled* Spouse/companion name OR Please drop my spouse/companion only from my membership effective 30 days from the above date. I understand that if I choose to rejoin and continue with my exercise program within a year of my cancellation date I will be assessed a 50 rejoin fee. I understand that if I choose to rejoin and continue with my exercise program within a year of my cancellation date I will be assessed a 50 rejoin fee. Method of payment How have you paid your dues please circle Payroll Deduction Bank Draft Check Credit Card Cash Reason for canceling please circle Facility too small Financial Inconvenient Joining another gym Leaving for Summer No usage Parking Scheduling Leaving School Terminated Other Signature --------------------------------------------------------------------------------For office use Staff initials Notes T FORM UAMS Fitness Ctr Cancellation Form 6-12..

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