Wheaton Sport Center

Membership Change Request

Member Information
Today's Date:
Effective Date:
Member:
Spouse:
Membership Number:
Home Phone :
Cell/Work Phone :
E-mail:

Current Membership

Please select your current membership:

If you have a family membership, how many dependents are on the account?

Changing Membership to

Please select your membership change:

If you are changing to a family membership, how many dependents will be on the account?

Please check the following that apply:
Adding to Membership Deleting from Membership

Name: Age: Birth date:

Additional Comments:

There is a $10 charge for all membership changes. Additional fees may be required for membership upgrades. Please allow seven business days for changes to be made.

Please type your name and date this will serve as your signature and agreement to the above document.

Member Name: