Program Refund Request- Recreation Center

Refund Request

Fitness Class
- Fitness Class
Name of Class
Aquatics Class
- Aquatics Class
Name of Class
Safety Class
- Safety Class
Name of Class
Membership Payment
- Membership Payment
Membership Dates
ASI Code*
Refund Amount Requested*
Fusion Invoice Number*
Fusion Order Number*
MS Number*
Reason for Request*
Name*
First Last
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Email*
Phone*
Consent*
I have read and understand the following:*
Form must be filled out completely for refund to be considered. All requests will be evaluated according to the refund policy. Resale items are not refundable.
Date*
MM slash DD slash YYYY
Signature*
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