Required fields are marked with asterisks (*)

Membership Change Request

This form can be filled out to request membership holds and cancellations. For more information, email memberships@lloydminster.ca

Your personal information is being collected under the authority of section 25 of the Local Authority Freedom of Information and Protection of Privacy Act. This information will only be used to administer the program/activity it was collected for. If you have any questions about the collection please contact the Office of the City Clerk at 780-875-6184 or email cityclerk@lloydminster.ca

First Name:

Last Name:

Phone Number:

Email:

Is this membership for the Bioclean Aquatic Centre or Servus Sports Centre?

Bioclean Aquatic Centre

Servus Sports Centre

Multi-Facility Membership

Reason for cancellation

Last date of membership use:

Would you like credit on your account or a refund?

Credit on Account

Refund

Forms

Membership Change Request