Anytime Fitness TERM MEMBERSHIPS Cancellation Form

1
WHICH CLUB ARE YOU A MEMBER OF? (Check one)* This field is required.
2
Member Name* This field is required.
First Name
Last Name
3
Phone Number* This field is required.
Area Code
Phone Number
4
Email* This field is required.
example@example.com
5
Reason for Cancellation* This field is required.
Medical
Re-location
Non-usage
Finances
Other
Other
6
Please explain why you are cancelling. Your feedback is invaluable as we grow as a business. We work hard to ensure members are happy and get a clean, comfortable workout environment.
7
Will you be returning to Anytime Fitness at a later date? If yes, you should consider FREEZING your account to hold onto your membership status. To FREEZE, email Jody at ruckersvilleva@anytimefitness.com.* This field is required.
Yes
No
8
I understand and agree to the following: I am cancelling my agreement with Anytime Fitness. Any Enrollments or Security Activations will be cancelled with the agreement.
Yes
9
CANCELLATION POLICY* This field is required.PLEASE READ: You have a TERM MEMBERSHIP. To cancel this type of agreement, you must break the term you signed up for. The cancellation fee for breaking the term early is $100 and a 30 day notice. Any payments that fall within these 30 days is still due as well as any past due payments and club enhancement fees. The $100 payment will be deducted with the last payment made in the 30 days. Your 30 days will start when this form is submitted.
I understand and agree
10
I understand that the date stamped below is the OFFICIAL START DATE OF MY 30 DAY CANCELLATION NOTICE. My official cancellation date will be 30 days past this date. Remember, all payments within these 30 days will be due with the $100 early cancellation fee deducted with the last payment. Payments that go past due WILL NOT CANCEL.* This field is required.
Date
Month
Day
Year
11
Member Signature WE DO APPRECIATE YOUR MEMBERSHIP AND WISH YOU THE BEST OF HEALTH!* This field is required.
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