Change

Your membership may be changed by completing this form any time during the current contractual year. All changes can be approved within the current year, however, downgrades will not take place until April 1 of the next year.

Name(Required)

First Last

Address (current)(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Cell Phone(Required)

Email(Required)

Check all that apply.(Required)

Which type of Upgrade would you like?(Required)

Fitness Tour ($10.00/mo.)

Fitness Plus ($22.99/mo.)

Play Everything Individual ($34.99/mo.)

Play Everything Couples ($44.99/mo.)

Play Everything Family ($54.99/mo.)

Reason for Cancellation(Required)

Employer is now covering my GreatLIFE membership dues

Member was called to active military duty

Self or spouse employment transfer

Financial situation has changed

Joined another facility

Other

I hereby turn in my notice to cancel my membership with GreatLIFE Golf & Fitness. I realize that if I decide to rejoin, I may be required to pay another initiation fee. I realize that I am responsible for any balance on my account (charges and dues) through the end of the fiscal year (March 31).

What is the new name?(Required)

Name

First Last

Date of Birth

Relation to Member

Name

First Last

Date of Birth

Relation to Member

Name

First Last

Date of Birth

Relation to Member

Address (new)(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Best Number to Call(Required)

Home Phone

Work Phone

Cell Phone

Best Time to Call(Required)

Morning

Afternoon

Evening

Other

Home Course/Facility(Required)

I authorize GreatLIFE Golf & Fitness and the financial institution named on the attached check or deposit slip to deduct, the amount of my monthly dues and any charges made to my membership account, from the account identified on the attached check or deposit slip. I understand my automatic payment will be deducted on the 15th day of each month. If the 15th falls on a weekend or bank holiday, the deduction will be drafted on the next business day following the 15th. Changes in account or bank information must be submitting in writing to GreatLIFE Golf & Fitness. Changes must be received prior to the 1st business day of any given month in order to be processed for that month's payment. Canceling a bank draft does not cancel a membership or cancel charges accrued to the membership account. In the event that a bank draft is revoked or an account is closed and new bank information is not received, the membership will be transferred to the "annual payment" option and the remaining amount due under the terms of the contract will be owed. Early termination (prior to April 1 of any given year) will only be accepted in the event of a member who passes away or a member who has accepted military assignment out of the area for more than 30 days. A $30.00 return fee will be charged for each returned bank draft.

GREATLIFE TOPEKA

change it up!

Membership Change request Form

GreatLIFE Topeka

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