Your Name *
Your Email *
Your Phone *
Your Bar Code Number
Reason for Leaving * Please Select OneHave movedMedical reasonJoined another gymNot using the gymWork scheduleNot satisfied
Your Home Club Queen AnneLaurelhurst
Did you join online? * NoYes
30 DAY CANCELLATION REQUEST NOTICE: By checking this box and clicking the “Submit” button on this page, I acknowledge that the cancellation request can take up to 30 (thirty) days to be processed. I further acknowledge that if my next scheduled billing date is less than 30 days from the submission date of this form, I WILL be billed as per terms outlined in my contract.
TERMS and CONDITIONS By checking the “Terms and Conditions” box and clicking the “Submit” button on this page, I understand that I authorize the processing of my membership at The Seattle GYM (THE GYM). I Acknowledge that the above information is accurate and correct. Any misrepresentation with the current information are the sole responsibility of the undersigned. Furthermore, I understand that the cancellation of my membership will be executed as per the terms and time frame outlined in my membership agreement. I understand that returning members may be subject to increases in initiation fees, membership dues, freeze fees, et. I authorize THE GYM to charge my credit card that is on record with THE GYM for any outstanding balances that remain on my account upon the successful cancellation of my membership.
I understand that this is only a request for cancellation of membership and the cancellation date of my membership will be communicated to me upon the successful review of my membership agreement and account by a membership account representative at THE GYM.