Southland

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SOUTHLAND PARK SOUTHLAND PARK FITNESS CENTRE #83 — 10333 Southport Road SW Calgary, Alberta ‘T2W 3X6 Membership Cancellation Notification EFFECTIVE DATE: YY MM ‘DD Qoad o4 4 ‘NAME (PLEASE PRINT) i ee COMPANY NAME Kiewit Co oRATION REASON FOR CANCELLATION: UL) lok for cancellations effective atthe + than the 20th ofthe month, 0.00 Administrative Fee for Tenants to Re-Join. This form must be submitted no late he initial three month minimum term of membership END OF THE MONTH. There is a $5 ‘Cancellation will only be effective once th has been completed FT MMT DD | MEMBER SIGNATURE

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