Membership Cancellation Request Form

Membership Cancellation Request
Date

MonthDayYear
Date
Name

First NameLast Name
Phone Number
Email
example@example.com
What is the main reason for cancelling your membership?

FinancialNon-UsageRelocationCould not find a mateMotivationOther
Membership Plan
CAUTION: When cancelling your membership, you can no longer attend events, travel excursions at huge discounted prices. However, if you are receiving coaching sessions, your plan will not be interrupted or terminated.
How often do you use the club?

Once a monthOnce a week2-3 times a week4+time a weekOther

We want your input!

	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?
I hearby certify that I wish to cancel my membership with Anytime Fitness. 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
Should be Empty:

Membership Cancellation Request