Membership Cancellation Request

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* 1. Your Personal Information

Full Name:

Email:

Best Phone To Reach You:

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* 2. How long have you been a member?

Less than six months

Six months to a year

1 - 2 years

3 or more years

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* 3. Why are you terminating your membership? [Select ALL that apply]

Moving from Cleveland

Moving more than 15 miles away

My membership term is coming to an end

I am joining another health club

I am unsatisfied with the staff

I am unsatisfied with the services and equipment

I am unsatisfied with my results

Other (please specify)

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* 4. Overall, how satisfied or dissatisfied are you with EB Fitness?

Very satisfied

Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

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* 5. How likely is it that you would recommend us to a friend or colleague?

Not at all likely

Extremely likely

0

1

2

3

4

5

6

7

8

9

10

0

1

2

3

4

5

6

7

8

9

10

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* 6. Do you have any other comments, questions, or concerns?

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* 7. I understand that this request is subject to all the club rules under my membership contract.

Yes

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* 8. If I Should permanently move my residence more than 25 miles from an affiliated center, payment on this agreement will be suspended upon payment of an appropriate cancellation fee of $50.00 and legitimate certification of the move such as utility bill. I understand that I will be responsible for all payments and fees under the contract.

Yes

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* 9. In case of an open end membership, this will serve as my 30-day written notice that is required under the contract.

Yes