Membership Cancellation Request
Date
*
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
What is the main reason for cancelling your membership?
*
Medical
Financial
Non-Usage
Relocation
Motivation
Other
How often do you use the club?
*
Once a month
Once a week
2-3 times a week
4+time a week
Other
On a scale of 1-5 (5 being the highest), how do you rank your overall experience at Anytime Fitness?
*
Which of the following services did you use at the club?
*
Fitness Consultation
Small Group Training
TEAM Training
1-on-1 Training
Tanning/Massage
Anytime Fitness App
Other
We want your input!
*
Definitely
Probably
Not Sure
Probably Not
Definitely Not
Will you use our service in the future?
Will you recommend our service to others?
I hearby certify that I wish to cancel my membership with Anytime Fitness. I understand that my account must be in good standing in order to complete this requst. I understand that I am responsible for any billing that will occur within the next 30 days. I understand I will be provided a copy of the Member Cancellation request via email.
Name
*
First Name
Last Name
Signature
*
Internal Use Only
Cancel Date:
*
-
Month
-
Day
Year
Date
Payment Balance (30 Days After Cancel Date)
*
Membership End Date
*
-
Month
-
Day
Year
Date
Last Usage Date
Consultation Offered
Yes
No
Options Offered
Active OS Agreement
*
Yes
No
Additional Notes
Anytime Fitness Rep
*
First Name
Last Name
Submit
Did you meet those goals?
*
Yes
No
Should be Empty: