First Name

Last Name

Email Address

Phone

Select best option that best describes your reason for leaving Select best option that best describes your reason for leaving *Too ExpensiveLocation Inconvenient/RelocatingWorkouts too difficultMaternityInjuryLack of attednance

How would you describe the coaching you received? How would you describe the coaching you received? *Extremely satisfiedVery satisfiedModeratley satisfiedSlightly satisfiedNot satisfied at all

How clean were the facilities? How clean were the facilities? *SatisfactoryUnsatisfactory

How satisfied were you with your overall experience? How satisfied were you with your overall experience? *Extremely satisfiedVery satisfiedModeratley satisfiedSlightly satisfiedNot satisfied at all

Would you recommend us to your friends? Would you recommend us to your friends? *YesNo

Additional Comments

I understand this is a request to cancel and they gym’s policy on cancellation will be considered to determine the final date of my membership (a mandatory box that must be checked with the word I understand this is a request to cancel and they gym’s policy on cancellation will be considered to determine the final date of my membership (a mandatory box that must be checked with the word Yes