Dan Abraham Healthy Living Center Cancellation Form

Dan Abraham Healthy Living Center

Membership Cancellation
Please complete the following fields. All fields are required. Please allow 72 hours for processing.

For any questions, please contact us by email: dahlc@mayo.edu, or by phone: 507-266-4688.

Form should be completed by the Responsible Mayo Clinic employee.
Responsible Party Information

This is the responsible party for the membership
Employee Email*
Must end @mayo.edu
Employee ID*

Canceling Member Information
Member Employee ID (If exists)
First Name of Membership being cancelled*
Middle Name of Membership being cancelled
Last Name of Membership being cancelled*
Birth Date of Membership being cancelled*

MonthDayYear
Date