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Telephone: ________
Email: ________

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________
Attention: ________
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Sent by: ________

Dear Sir or Madam:

Re:  Notice of Cancellation of Membership — Account No. ________

§ 1.  Purpose of Notice. I, ________, am writing to provide formal written notice that I am cancelling my membership and the related agreement (the “Agreement”) entered into with ________ (the “Organization”) on or about ________.

§ 2.  Membership Particulars. The membership to which this notice relates is identified as follows:

1. Member name: ________;
2. Account / membership number: ________;
3. Membership type or plan: ________; and
4. Membership location or branch (if applicable): ________.

§ 3.  Effective Date of Cancellation. I hereby cancel the Agreement effective ________, or, where the Agreement or applicable law requires a longer notice period, on the earliest date thereafter permitted in accordance with the cancellation and notice provisions of the Agreement.

§ 4.  Statutory Cancellation Rights. To the extent applicable, this notice is given pursuant to, and I expressly reserve and rely upon, all rights available to me under the applicable consumer protection legislation of the Province of ________, including any statutory right to cancel a future performance, time-share, personal development, fitness, or continuing-services contract, any applicable cooling-off period, and any right to cancel where required disclosure was not provided. Nothing in this notice shall be construed as a waiver of any such right.

§ 5.  Cessation of Charges and Payment Authorizations. As of the effective date set out in § 3, I withdraw and revoke any authorization previously given to the Organization, whether by pre-authorized debit, credit card, or otherwise, to charge or debit any account of mine, and I direct that no further fees, dues, renewals, or other amounts be charged to me. Particulars of the payment method to be discontinued: ________.

§ 6.  Refund of Prepaid or Overpaid Amounts. If any amount has been prepaid or is otherwise owing to me as a refund upon cancellation, I request that it be calculated in accordance with the Agreement and applicable law and remitted to me at the address noted above, or by ________, within ________ days of the effective date of cancellation.

§ 7.  Return of Property. I confirm that I have returned, or will return upon your instruction, any access cards, keys, equipment, or other property of the Organization in my possession: ________.

§ 8.  Request for Written Confirmation. Kindly provide me with written confirmation, within ________ days of receipt of this notice, that: (a) my membership has been cancelled; (b) the Agreement is terminated; (c) all recurring charges and payment authorizations have been stopped; and (d) my account is settled in full or, if applicable, the amount of any refund payable to me.

§ 9.  Enclosures. Enclosed herewith are the following (if any): ________.

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Yours truly,

________

Signature: ________
Date: ________