Recreation & Community Center Membership Cancellation and Adjustments Form for PRCS

Recreation & Community Center Membership Cancellation and Adjustments Form

This form provides the opportunity for Recreation & Community Center members to submit cancellation requests or level adjustments for their Loudoun County Parks, Recreation & Community Services (PRCS) memberships.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

CityState / Province

Postal / Zip Code
Requests submitted 7 or more days before the monthly auto-renewal date will not incur future charges and membership access will continue up until the renewal date.

Requests submitted 6 days or less before the monthly auto-renewal date may incur the upcoming monthly charge but will not be renewed the following month and membership access will continue through the last month paid.
Membership CancellationsMembership Level Adjustments
Ashburn Recreation and Community CenterClaude Moore Recreation and Community CenterDulles South Recreation and Community CenterNot Sure
Only my membership in the household cancelledAll memberships in the household cancelledSome memberships in the household cancelled
Please enter the names of the memberships you would like cancelled
Only my membership in the household adjustedAll memberships in the household adjustedSome memberships in the household adjusted
Please enter the names of the memberships you would like adjusted and the level to which you would like the adjustment to be made
YesNo
Cancellation reasoning
After your membership changes have been processed, you will receive an email confirmation with your membership end date for cancellations or confirmation of the adjustments for level changes.
ImmediatelyBefore my next billing date
Please select the date you would like your changes to go into effect:

MonthDayYear
Date
Should be Empty: