High Desert Membership Cancellation Request Form

Membership Cancellation Request
Date

MonthDayYear
Date
Name

First NameLast Name
Phone Number
Email
example@example.com
What is the main reason for cancelling your membership?

MedicalFinancialNon-UsageRelocationMotivationOther
How often do you use your membership?

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 High Desert CrossFit?
What were your desired health goals when you joined High Desert CrossFit?
Did we help you meet those goals?

YesNo
How can we improve our service?
I hearby certify that I wish to cancel my membership with High Desert CrossFit. I understand that my account must be in good standing in order to complete this request. I understand that I must give a 30 days notice of cancellation per the ACH/CC Transaction Agreeement, and I am responsible for any billing that will occur within the next 30 days. I understand that in order to re-activate my membership, it will require a 3 month membership commitment.
Name

First NameLast Name
Signature

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Cancel Date:

MonthDayYear
Date
Payment Balance (30 Days After Cancel Date)
Membership End Date

MonthDayYear
Date
Additional Notes
Should be Empty:

Membership Cancellation Request