Full Name * If member is a Minor, Parent/Guardian Name

Requesting Date *

Email Address * Example: user@website.com

Phone Number * Example: 2126951962

Acknowledgement of Cancellation — Yes, I agree with the Membership Agreement Cancellation Policy *

By submitting this form, I understand and acknowledge the following:

This form serves as my official written notice of cancellation in accordance with my Membership Agreement.
My required 30-day notice period begins on the date this form is submitted.
I may continue attending classes during my 30-day notice period.
I understand that I am financially responsible for all membership dues owed during my 30-day notice period, regardless of my attendance.
I understand that Rafael Japur BJJ LLC may process payment for my remaining 30-day notice period using the payment method on file.
I understand that if I am canceling before completing my current membership term, any applicable early termination fee outlined in my Membership Agreement may apply.
I understand that no prorated refunds will be issued.

By typing my name below, I certify that the information provided is accurate and that I am submitting this cancellation request voluntarily. *

Type Your Full Name * Your Full Name will be Used

Today's Date *

What Happens Next?
Once your form has been submitted:

You will receive confirmation that your cancellation request has been received. Your membership will remain active during your required 30-day notice period.
Your account will be reviewed and processed according to the terms of your Membership Agreement.
You will receive a final confirmation once your cancellation has been completed.

Thank you for being a valued member of Rafael Japur BJJ. We truly appreciate your support and wish you all the best. Our doors are always open, and we hope to welcome you back in the future.

Membership Cancellation Request Form