Private and Confidential
Membership Cancellation Request Form

Your Details

Required Fields *

Title *

First Name *

Last Name *

Home Address *

Postcode *

Phone (optional)

Mobile (optional)

Email *

Type of Membership

GoCardless ID

Go Cardless ID *

Reason For Cancellation (select all that apply)

Personal/Time Restrictions Lack of Use Level of Service Financial Reasons Cost of Membership Moving Away Completed Course Other (please specify)

Other reason

Please complete this short survey to help us improve our service:

Please rate your overall satisfaction level with Planet Ice:

What is the one thing you LIKE most about Planet Ice?

One thing you LIKE most

What is the one thing you DISLIKE most about Planet Ice?

One thing you DISLIKE most

Please note you need to give at least one months notice if you wish to cancel your membership. If at any time you return to Planet Ice an admin fee charge may apply for setting up your new direct debit membership. (Terms & Conditions apply)