Membership Cancellation Request Form

Cancellation Policy Orangetheory Fitness offers a 30-day cancellation policy unless otherwise stated in your Membership Agreement with the studio where you purchased membership ("Home Studio" Please review your Membership Agreement or contact your Home Studio for applicable membership cancellation options including all related billing and refund information. Membership may be cancelled by completing a copy of this form at your Home Studio or sending a cancellation notice to your Home Studio as provided in your Membership Agreement. To process membership cancellation, your membership status must be active. In the event your membership status is frozen, you must reactivate your membership in order for membership cancellation to be processed. Under the 30-day cancellation policy, any membership payment set to occur within 30-days after receipt of your cancellation request will occur as scheduled. You will have 30 days from the last membership payment date to utilize any previously unused sessions. Any sessions remaining after the expiration of the 30-day window following the last membership payment date will be forfeited. To be completed by Member:

Please rate our performance at your Home Studio by circling the response which best represents your outlook. Quality of Workout Unsatisfactory Unsatisfactory Unsatisfactory Unsatisfactory Unsatisfactory Overall Experience with Orangetheory Fitness

Front Desk Customer Service Convenient Class Times Cleanliness of the Studio

Good Great Good Great Good Great Good Great Good Great

Reason for Cancellation: Please circle one of the reasons below.

Downgrade/UpgradeNo Time to Attend Financial

To be completed by Studio: Member Since: I have spoken to the member and discussed cancellation options and procedures. I have spoken to the member about the termination date and provided any remaining session information.

Enter and Verify in MBO: Membership Termination Date: Number of Class Sessions Remaining (If any):

Last Electronic Funds Transfer (EFT) Date: Class Session Expiration Date:

Signatures , acknowledge that all applicable cancellation procedures and dates have been explained to me, including any EFT remaining in the cancellation period and the timing in which I may use any previously unused sessions prior to such sessions being forfeited after the expiration of the 30-day window following the last membership payment date.