MEMBERSHIP CANCELLATION FORM  
 
Complete the form below to submit your cancellation request.
   
FIRST NAME:
 
 
 
PHONE NUMBER:
 
SCAN TAG #:
 
LOCATION:
Englewood
Montvale
 
We are always looking to improve, please let us know why you are leaving:
 
30 DAY CANCELLATION NOTICE:
 
By checking this box and clicking the "Submit" button on this page, I acknowledge that the cancellation request can take up to 30 (thirty) days to be processed. I further acknowledge that if my next scheduled billing date is less than 30 days from the submission date of this form, I WILL be billed as per the terms outlined in my contract.
   
TERMS and CONDITION:
   
By checking the "Terms and Conditions" box and clicking the "Submit" button on this page, I understand that I authorize the processing of my membership at THE GYM. I acknowledge that the above information is accurate and correct. Any misrepresentation with the current information are the sole responsibility of the undersigned. Furthermore, I understand that the cancellation of my membership will be executed as per the terms and time frame outlined in my membership agreement. I understand that returning members are subject to increases in initiation fees, membership dues, freeze fees, etc. I authorize THE GYM to charge my credit card that is on record with THE GYM for any outstanding balances that remain on my account upon the successful cancellation of my membership.
   
I understand that this is only a request for cancellation of membership and the cancellation date of my membership will be communicated to me upon the successful review of my membership agreement and account by a membership account representative of THE GYM.
   

 
 

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