MEMBERSHIP CANCELLATION FORM

First Name *

Last Name *

Address *

City *

State *

Phone *

Email *

Please indicate your reason(s) in which describes your need to cancel your membership? *

Financial Situation

Health-Related

Non-Usage

Re-Location

Issues with Facility

Other(please explain):

Is there anything you would change about DUBb FITNESS? *

Rate Your Overall Experience At DUBb FITNESS(1 poor, 5 excellent) *

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2

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5

Can we reach back out to you in 90 Days?

Signature *

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