First Name *

Last Name *

Email (please use address to which we send regular communication) *

Reason For Cancellation *

Please select the option below that best describes your reason for cancelling your membership

How well did the Coaching Staff attend to your fitness goals and needs? *

Overall, how would you rate your experience training with us? *

How likely are you to recommend our gym to family and friends? *

I AGREE TO THE CANCELLATION TERMS*

- I understand that my membership will be cancelled 14-days from the date this form was submitted.
- I understand my final payment may be prorated based on the remaining days left of my membership.
- I understand that I may be subject to new membership rates if I rejoin the gym at a later stage.