Membership Cancellation Request
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1
2MEMBERSHIP CANCELLATION REQUEST
Member Name (print): _______________________________________________
Reason(s) for Cancellation:
Moving
Facility
Personal
Local
Broken Equipment
Medical/Injury
Outside DC Area
Locker Rooms
Military
Job Related
Overcrowded
Not Using Facility
Services
New Job – Outside DC Area
Too Expensive
Retirement
Poor Customer Service
15 Day Cancellation
Joining Another Gym
Personal Training
Gym at Work
Group Programming
Gym in Condo/Apt Bldg
Not Enough Cardio
Other
(Please specify below):
___________________________________________________________________________
Please note: If cancelling within first year of membership, you must provide proper documentation in order to
satisfy the eligibility requirements for membership cancellation as outlined in the membership agreement. Please
attach a new lease, deed or utility bill, employment relocation paperwork, or a letter from your doctor to this
cancellation form.
I understand that my cancellation date (actual last day of membership) will be the end of the membership
•
period following my next scheduled billing date. I understand that I must submit any required documentation
and my membership account must be paid up to date in order for this cancellation to be processed.
•
I understand my final billing will include a standard $25 Cancellation Processing Fee. Please note: The
cancellation fee applies to all membership types regardless of length of membership with the exception of
the $129/month “Month-to-Month” membership.
Member Signature: __________________________________ Date: ___________________
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Staff Use Only
Home Club:
City Vista
Metropole
Renaissance
The Yards
U Street
Verizon
Obligation Date: ____________________
Documentation Attached:
Y
N
N/A
Cancellation Fee: ________
One Additional Billing Date : ______________
Amount: __________
Received by: ___________________________________________ Date: ____________________
Processed by: ___________________________________________ Date: ____________________
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Parent category: Business