Membership Cancellation Request Form

Membership Cancellation Request
Date

MonthDayYear
Date
Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
MedicalFinancialNon-UsageRelocationMotivationOther
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 24/7 Fitness Club?
What were your desired health goals when you joined the club?
YesNo
How would meeting those goals have impacted your life as it is today?
If you could choose your price, what would you pay for a gym membership at this facility?
Fitness Consultation1-on-1 Training24 Hour GymOther
If you took advantage of your Fitness Consultation, did it meet your expectations?
Did staff provide a good customer experience?
Did you find your staff knowledgeable?
Did you find your gym clean?

We want your input!

Rows	Definitely	Probably	Not Sure	Probably Not	Definitely Not
Will you use our service in the future?
Will you recommend our service to others?

How can we improve our service?
Two FreeOne-On-One Training SessionsOne Month FREE MembershipNone
I hearby certify that I wish to cancel my membership with 24/7 Fitness Club. I understand that my account must be in good standing in order to complete this requst. I understand that I am responsible for any billing that will occur within the next 30 days. I understand I will be provided a copy of the Member Cancellation request via email.
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
Last Usage Date
YesNo
Options Offered
YesNo
Additional Notes
Anytime Fitness Rep

First NameLast Name
Should be Empty:

Membership Cancellation Request