Membership Cancellation Form – Student Affairs Forms

This form must be submitted to cancel monthly automatic payment memberships. Complete each of the below fields and submit. Must be submitted prior to the last day of the month to be charged. Upon successful processing of the cancellation, membership will expire on the 2nd day of the upcoming month prior to the monthly billing cycle.

You will receive an email with your submitted information. Retain this email as record of cancellation.

Membership Cancellation Form

Todays Date *

Main Member Name *

Main Member's SMU ID Number *

Main Member's Email *

If applicable, enter the Spouse-Partner Name

If known, Spouse-Partners SMU or Dedman ID Number

Please indicate the membership to cancel *

Main Member Only (all sub-members related to main member will be cancelled)

Spouse-Partner Only

Bundled Membership

Please select the method of monthly payment for your membership *

Monthly Automatic Payroll Deduction

Monthly Automatic Credit Card Deducation

Please Provide a Reason for Cancellation

If you are human, leave this field blank.

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