Membership Cancellation Request Form

Membership Cancellation Request
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
What is the main reason for cancelling your membership?

Other
How often do you use the club?

Other
On a scale of 1-5 (5 being the highest), how do you rank your overall experience at Anytime Fitness?
What were your desired health goals when you joined the club?
Did you meet those goals?
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?

Other
If you took advantage of your Fitness Consultation, did it meet your expectations?
Did staff provide a good customer experience?
Did you find your staff knowledgeable?
Did you find your gym clean?

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?
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 text or email.
Name

First NameLast Name
Signature
Internal Use Only
Date requested:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
30 Day notice payment due date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Membership End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date Processed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Consultation Offered
Options Offered
Active OS Agreement
Additional Notes
Anytime Fitness Rep

First NameLast Name
Should be Empty:

Membership Cancellation Request