Membership Cancellation

If you see this don't fill out this input box.

This form is for KSU staff and faculty cancellation only. Family members must complete the form located at: https://employeewellness.kennesaw.edu/fitness-center/Payroll%20Deduction%20Form.pdf

*First Name

Middle Initial

*Last Name

*KSU ID #

*Email Address

*Cancellation Effective Date

When You Want Cancellation To Take Effect

*Payroll Deduction Amount

*Previous Payroll Deduction Frequency

I am a Kennesaw State University employee and I hereby request that Kennesaw State University cancel the deduction for Employee Fitness Center Membership Dues from my paycheck as indicated above.

I understand that requests submitted after the 15th of the month, will not be processed until the following month as to not interfere with payroll processing.

*Electronic Signature