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Membership Cancellation Form
Form must be completed to start Cancellation process.
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1
Member Name
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First Name
Last Name
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2
Phone Number
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Area Code
Phone Number
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3
Email
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example@example.com
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4
Reason for Cancellation
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Medical
Re-location
Non-usage
Finances
Other
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5
Rate Your Overall Experience at Anytime Fitness (1 is poor, 5 is great)
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1
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5
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6
Please explain, your feedback is invaluable as we grow our business. We want every member to leave happy and knowing we fulfilled our duty as a fitness and wellness center.
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7
Do you think you will return to Anytime Fitness at a later date? IF YES, you should consider FREEZING your agreement to save your Enrollments and Security Activations. Please email ruckersvilleva@anytimefitness.com for a FREEZE form instead.
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Yes
No
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8
I understand and agree to the following: I am cancelling my agreement with my Anytime Fitness, all Enrollments and Security Activations when I joined will be cancelled with the agreement.
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Yes
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9
You have one of two types of memberships. Cancellation policies of each are below. If you are not sure which membership type you have, you may email ruckersvilleva@anytimefitness.com to find out.
TERM -
This means you are still inside a term agreement. To break this agreement is a $100 early cancellation fee plus a 30 day notice. Any payments that fall within these 30 days is due as well as any past due payments and club enhancement fees. Your membership will fully cancel 30 days AFTER your last payment date.
OPEN END -
This means you have completed your term agreement and the early cancellation fee is waived. The 30 day notice policy is in effect. Any payments that fall within these 30 days is due as well as any past due payments and club enhancement fees. Your membership will fully cancel 30 days AFTER your last payment date. *Not checking you agree will result in your cancellation not being processed.
I understand and agree
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10
I understand that the date stamped below is the official start date of my 30 day cancellation process. Any payments due including past due and club enhancement fees will be due within these 30 days AND my membership will fully cancel after the last payment date IF ALL THESE CRITERIA ARE MET. Today's date should be time stamped below, changing this date will nullify the cancellation process.
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-
Date
Month
Day
Year
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11
Member Signature
(Not signing the form will nullify the cancellation process unless given permission by club owner whom you can email at ruckersvilleva@anytimefitness.com.
THANK YOU FOR YOUR MEMBERSHIP AND WE WISH YOU THE BEST OF HEALTH.
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