Online Membership Termination Request Request to Terminate Membership (membership payments will not continue at the end of the required, paid month) Member Name*Must be name of person holding this membership (primary member). First Last Barcode Number5 digit number used to check-in.Member Email Address*Email required to send confirmation. Enter Email Confirm Email Member Birth Date* MM DD YYYY Member Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Member Home Phone*Member Cell Phone*Reason for Termination*DistanceFacility CrowdingPriceHours of OperationMedicalMonetaryNo Longer EmployedNon-UsageProgram/ServicesRelocationSwitching to Another FacilityIf you selected "switching to another facility" above, which facility are you swtiching to?Please read each statement below, then select each checkbox as receipt of acknowledgement.*All statements must be accepted in order to process the termination request. The billing on this account will be charged one more month if a seven-day notice prior to the billing date is not provided. Billing may be updated by calling the membership service desk, 724-452-9122. Memberships terminated for longer than two months will be reassessed the development fee. This fee does not apply to youth memberships. I understand family members cannot be registered in any program that runs after membership termination. Account will be charged non-member price difference for program if membership termination is submitted. Authorized Signature*I, the requesting party, understand there is a required seven-day notice prior to my billing date before this membership termination will commence. (Billing date of 1st of month or 15th of month is given based on your chosen preference when you joined.) Typing your name below will act as your authorized signature, by which you agree to the terms listed throughout. First Last Membership Termination is NOT COMPLETE until member receives emailed confirmation of this request.