Membership Change/Cancellation Form

SJCC Membership Change Form
Membership Account Holder Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
E-mail Address*
Phone Number*
Type*

CellHomeWork
Contact Denise Ipock, Membership Coordinator, at DeniseI@sjcc.org or 206-829-2594 to update your payment information.
I would like to make the following change(s) to my membership*

Make changes to my membershipPut my membership on holdCancel my membership

Membership Holds

To put a membership on hold, we require a start date and an end date. If you are on a monthly billed contract, your hold will start at the end of your current month. Upon receipt of this form, we will charge a one-time $35 hold fee. Billing will automatically resume on the next billing cycle after the end date of your hold.

You are eligible to put your membership on hold once per calendar year, for up to three months.
Hold Start Date*

MonthDayYear
Hold End Date*

MonthDayYear
Must be within 3 months of Hold Start Date
Reason for putting your membership on hold
Calculation - Hold Duration
Membership Holds cannot exceed three (3) months. Please select a Hold End Date within 3 months of your Hold Start Date.

Cancellation
We require 30 days' notice to cancel your membership, which will start from the day we receive this form. We do not offer refunds for partial months. If you cancel your membership before your initial 12-month commitment, your monthly obligation continues.
We are sad to see you go! Please let us know why you are cancelling your membership.*

Health or medical reasonsMoved out of areaI am not using my membershipJoined elsewhereMy children have aged out of programsToo expensiveOtherOther
Do you have other feedback or comments to share?

By typing your name below, you authorize the Stroum Jewish Community Center to make changes to your membership account and charge any fees related to those changes as outlined in your membership agreement. All payments, including but not limited to those for membership change fees, are non-refundable. Please see the terms & conditions section of your membership agreement for further details.*
Signature
By entering your name below, you authorize the Stroum Jewish Community Center to make changes to your membership account and charge any fees related to those changes as outlined in your membership agreement. All payments, including but not limited to those for membership change fees, are non-refundable. Please see the terms & conditions section of your membership agreement for further details.*

Clear
Thank you for your updates. You will be notified once we have processed changes. Please allow 5 business days for changes to be made. If you have any questions, please contact Denise Ipock, Membership Coordinator, at DeniseI@sjcc.org or 206-829-2994.
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Membership Changes