MEMBERSHIP CANCELLATION REQUEST FORM

MEMBERSHIP CANCELLATION REQUEST FORM
Name

First NameLast Name
Email
example@example.com
Requested Cancellation Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate (allowing the required 14 days notice)
Reason for Cancellation
Can you tell us more about what prevented you from achieving your goals?
Would you like us to contact you about more affordable membership options?
Would you prefer to suspend your membership instead? You may suspend your membership for a minimum of 14 days and a maximum of 3 months.
Suspension Period Requested
Min 14 days, Max 3 months
Reason for Suspension
Overall, how would you rate your experience as a member at Hustle Fitness?
Is there anything we could have done better?
What did you enjoy most about your experience with Hustle Fitness?
If you wish to provide any other comments or feedback, please do so here. We would also greatly appreciate if you would like to provide a short testimonial that we can use for marketing purposes.
Testimonials may be used for promotional purposes on our website and/or social media profiles. Please state if you wish to remain anonymous.
Terms and Conditions

Please acknowledge our Terms & Conditions prior to submitting.
- All Hustle Fitness Memberships have a minimum term of 8 weeks. If you wish to cancel your membership during the minimum term, this will incur a fee equal to 2 weeks membership fees.
- A 14 day notice period is required when wishing to terminate your membership.
- Your membership fees will be due and payable during this 14 day notice period, and you will have the same access rights under the Membership Agreement for the full 14 day period.
- Once your membership cancellation request has been approved, we will confirm any remaining fees to be paid (i.e. account balances, any unpaid classes etc.), as well as the date upon which the cancellation will take effect.
Declaration
Admin Use Only
Approved By

First NameLast Name
Date of Approval

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Admin Notes
Approved Cancellation Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Final Payment Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Final Payment Amount
Suspension Start Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Suspension End Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Payment Resumes

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Processing
Should be Empty:

MEMBERSHIP CANCELLATION REQUEST FORM

Terms and Conditions

Admin Use Only