Membership Cancelation Form

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Phone Number* This field is required.
Please enter a valid phone number.
4
When would you like to cancel your membership?* This field is required.You must cancel AT LEAST 21 days before your next billing cycle is due, should you wish not to incur next month’s charges. This applies to Month-to-Month and contracted memberships. You may opt-out of the contract anytime and incur an additional 20% fee of the dollar amount remaining on your contract (if not paid in full). This fee is separate from your next month’s membership charge, should we not receive a minimum of 21 days’ notice. There will be no refunds for processed membership charges. Failure to attend class does not signify or imply notification to cancel this agreement.
Date
Year
Month
Day
5
What is the reason for your cancelation?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
6
Is there something we could have done better to keep you training with us at CrossFit La Verne?* This field is required.
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Large
Normal
Small
Ok
Ok
Should be Empty: