*
First Name
Last Name
Cancellation Request Form
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Membership Type
*
Student
Staff / Alumni
Other
Reason you are leaving?
*
Please Select
Lack of Motivation
Financial
Injury
Medical
Moving
Poor Experience
Using Another Gym
Other
Reason
*
Please provide your medical certificate for immediate cancellation:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
How often did you attend?
*
0 days per week
1-2 day per week
3-4 days per week
5+ days per week
What facilities did you use?
*
Group Fitness
Weights Room
Cardio Room
Women's Only Gym
Sports Hall
Bunker
Reformer
Rejuvenate area
Did you know you can suspend your membership free for up to 30 days?
*
Yes, please suspend my membership
No thanks, continue with my cancellation
Please enter your suspension start date
-
Day
-
Month
Year
Date
Please enter your suspension return date
-
Day
-
Month
Year
Date
Please enter your cancellation date (if longer than the 2-week cancellation period)
-
Month
-
Day
Year
Date
Overall Experience with FUSF
*
1
2
3
4
5
Any additional feedback to improve our service?
*
Submit
Should be Empty: