VIP Membership Cancellation Form
Location?
Name
First Name
Last Name
Level?
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cancellation Date
-
Month
-
Day
Year
Date
Reason for cancellation (in paragraph)
Financial situation, health related, staff issues, facility issues
Attach supporting documents like medical certificate
Browse Files
Drag and drop files here
Choose a file
Cancel
of
How would you rate our overall services?
1
2
3
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5
Provide any comments or feedback
Terms and Conditions
Cancellations before the 25th of the month will be effective the same month it was submitted.
Cancelations submitted after the 25th will be effective the following month.
Cancellation will only be accepted via this form and not by phone or email.
Client's Signature
Date Signed
-
Month
-
Day
Year
Date
Print Form
Submit
Authorized Use Only
Approved By
First Name
Last Name
Approver's Signature
Date Signed
-
Month
-
Day
Year
Date
Should be Empty: