We hate to see you go. Please fill out this form and we will be in touch with you shortly to finalize cancelling your membership.

First Name *

Last Name *

Phone *

Email *

Please select the option below that best describes your reason for leaving. *

How would you describe your satisfaction with the coaching you received from us? *

How clean were the facilities? *

How satisfied were you with your overall experience? *

Would you recommend us to your friends? *

Additional Comments/Questions

I understand that my membership will be cancelled 28 days from the date this form was submitted. Your next bill will be appropriately prorated from the date this form is submitted. *

Yes

If you decide to reactivate your membership in the future (and we hope you do) membership rates in effect at the time of reactivation will be applicable as membership rates are subject to change.

Yes

If you decide to reactivate your membership in the future (and we hope you do) membership rates in effect at the time of reactivation will be applicable as membership rates are subject to change. *

I Understand

If you would like to put your membership on hold instead of canceling, you can submit a Membership Hold Request. If you’re sure you’d like to cancel, just complete and submit the form below. This will serve as your 4 week written cancellation notice as required by your membership agreement. Your membership will be cancelled 4 weeks from the submission of the form below. Note that if you have a scheduled renewal payment within this 4 week period, the payment will be processed as scheduled. All payments are non-refundable and will not be pro-rated. *

I Understand

Cancellation of membership prior to the expiration of any specified commitment period requires an early termination fee equal to the standard non-discounted month-to-month rate. *

I Understand

Captcha

Your next bill will be appropriately prorated from the date this form is submitted.

PushPress Grow