Cancellation of Membership Form Request - Eclipse Gym Wolverhampton

1
Member or Members Name* This field is required.Please fill a separate form for each person requiring cancellation of membership.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Reason for Cancellation?* This field is required.Please briefly explain why you are canceling your membership.
Please explain briefly
4
Medical Note Provided* This field is required.If you are Cancelling due to injury or illness please provide official medical note (Needed if you are in a term membership , for example 1 year term and still in that year)
Yes
No
5
I understand that my account must be in good standing to qualify for a Cancellation* This field is required.I understand that the cancellation of my direct debit does not serve as proper notice. By submitting this form, I acknowledge that by submitting this form, I am initiating the 30-day notice period for the cancellation of my membership. I understand that any payments scheduled to be collected within the 30-day notice period will still be due in full, in accordance with the terms of my contract. If I am still within the initial 12-month contract term, I understand that cancellation can only take effect at the end of the agreed contract period, as stated in the membership agreement. If I am outside of my minimum contract term, a final payment will still be required before cancellation is completed. I also understand that if no official cancellation form is received, my membership and payments will continue as per the original agreement.
Yes
6
File attached (such as medical proof or moving away from area)This is only nessesary if still in a contracted membership and not month to month memberships.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Member SignatureParent signature if member is under 16 years of age.
Clear
Should be Empty: