First Name *

Last Name *

Phone *

Email *

Reason for cancellation *

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Injury
Conflict with scehdule
Financial hardship
Dissatisfied with service
Unmotivated
Need a break
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If selected other:

How well has the Coaching Staff attended to your fitness goals and needs? *

Excellent

Pretty Good

Just Okay

Need Some Work

Overall, how would you rate experience at our gym? *

Excellent

Pretty Good

Just Okay

Need Some Work

How likely are you to recommend our gym to others? *

Extremely Likely

Very likely

Somewhat likely

Neutral

Somewhat Unlikely

Very Unlikely

Not Likely At All

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I agree to the terms of the membership cancellation policy. I understand that after submitting the cancellation form, I am still responsible for any payment inside the 7 day notice window.

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