Cancellation RequestWe’re sad to see you go! Please complete the form below. Cancellation requests must be submitted 30 days prior to your next billing statement. Name * First Name Last Name Email * Phone * (###) ### #### Is there anyone else connected to your membership you'd like to cancel? List their name(s) Is there anyone else connected to your membership that would like to remain a member? List their name(s) Do you rent a locker? * (Please note your locker must be emptied prior to cancel date.) Yes No Please select your reason for cancellation: * Move or Relocation Low Usage Joined Another Gym Medical Cannot Afford Unhappy with Facilities Other (please specify below) Other Reason: Would you consider rejoining in the future? * Yes No Maybe Do you take group exercise classes? Please rate the following services: * The club was clean and well maintained. Strongly Disagree Disagree Neutral Agree Strongly Agree Front desk staff were friendly and helpful. Strongly Disagree Disagree Neutral Agree Strongly Agree Overall customer service was exceptional. Strongly Disagree Disagree Neutral Agree Strongly Agree I felt valued during my membership. Strongly Disagree Disagree Neutral Agree Strongly Agree I will re-join in the future. Strongly Disagree Disagree Neutral Agree Strongly Agree How could we have made your experience better? * Terms of Membership Cancellation * • I understand that this serves as a written notice for cancellation, and that this must be submitted and received 30 days prior to my next billing statement. The auto-pay of this agreement does not cease until cancellation is effective. • I understand that upon cancellation of my membership agreement, I may pay a pro-rated annual fee in accordance with my membership agreement if my membership start date was prior to 11/01/2019, as well as any past due account balances (all account balances must be brought to zero). • I understand, if I am in a termed agreement (contract), I can cancel one of three ways: (1) Submit proof of relocation 60 miles or further from the club with a $50 relocation fee. (2) A licensed medical practitioner sends written notice advising that I cannot or should not receive any services provided by 212 Fitness for a period exceeding six continuous months. (3) I can buy out of my contract at 50% of the remaining months. • I understand that if there are any unused services such as personal training, Pilates, team training, or other packages, I can redeem them until one-year from the date of purchase but am required to purchase a non-member guest pass to enter the facility. • If I wish to return to 212 Fitness, I understand that I will pay current pricing for my demographic plus any enrollment fees. I Agree Thank you, your form has been submitted.
