MEMBERSHIP CANCELLATION REQUEST FORM

MEMBERSHIP CANCELLATION REQUEST FORM
Name

First NameLast Name
Email
example@example.com
Phone Number
Format: 0000-000-000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cancellation Date

DayMonthYear
Date (allowing the required 14 days notice)
Reason for Cancellation
Financial situation, health related, staff issues, facility issues
How would you rate your overall experience at Hustle Fitness?
If you wish to provide any 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.
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 moths
Terms and Conditions
- 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.
Client's Signature
Date Signed

DayMonthYear
Date
Authorised Use Only
Approved By

First NameLast Name
Approver's Signature
Date Signed

DayMonthYear
Date
Should be Empty:

MEMBERSHIP CANCELLATION REQUEST FORM

Terms and Conditions

Authorised Use Only