Membership Cancellation Request
Date
*
-
Month
-
Day
Year
Date
Select your Home Club
Mt. Dora, FL
Winter Park, FL
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?
1
2
3
4
5
Worst
Best
1 is Worst, 5 is Best
What were your desired health goals when you joined the club?
*
Did you meet those goals?
*
Yes
No
How would meeting those goals have impacted your life as it is today?
If you could choose your price, what would you pay for a gym membership at this facility?
*
Which of the following services did you use at the club?
*
Fitness Consultation
Small Group Training
1-on-1 Training
Anytime Fitness App
Coaching Membership
Body Composition Scanner
Other
If you took advantage of your Fitness Consultation, did it meet your expectations?
Did staff provide a good customer experience?
*
1
2
3
4
5
Did you find your staff knowledgeable?
*
1
2
3
4
5
Did you find your gym clean?
*
1
2
3
4
5
We want your input!
*
Rows
Definitely
Probably
Not Sure
Probably Not
Definitely Not
Will you use our service in the future?
Will you recommend our service to others?
How can we improve our service?
We're sorry that failed getting you excited about your health and fitness goals! Give us another chance, with no obligation to stay. Select one of the below FREE options to allow us to better help you reach your fitness goals. Please rest assured, that your membership will still be cancelled as per your request.
*
FREE One Month Coaching Plus Membership
One Month FREE Semi-Private Training + Membership
$0 Enrollment Fee for a workout partner to join
$50 Gift Card Towards Membership and/or Training
Earn 3 FREE Months if you visit the club 10 times in one month
Freeze Membership instead of cancelling
None
Other
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
Should be Empty: