Membership Cancellation Request Form

Membership Cancellation Request
Name*

First NameLast Name
Date*

MonthDayYear
Date
Last Day of Membership (30 Days Notice Required)*

MonthDayYear
Date
Phone Number*
Email*
example@example.com
What is the main reason for cancelling your membership?*

MedicalFinancialNon-UsageRelocationMotivationOther
How often do you visit the gym?*

Once a monthOnce a week2-3 times a week4+time a weekOther
On a scale of 1-5 (5 being the highest), how do you rank your overall experience at Bolt Fitness?*
Did our team provide a good customer experience? *
Did you find our team knowledgeable and helpful? *
Did you find Bolt Fitness Covid safe and clean?*

We want your input!*

	Definitely	Probably	Not Sure	Probably Not	Definitely Not
Will you use our gym again in the future?
Will you recommend our gym to others?

How can we improve our gym? Any feedback is welcome!
I hereby certify that I wish to cancel my membership with Bolt Fitness. I understand that my account must be in good standing in order to complete this request. 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 NameLast Name
Signature*

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