Account Management — Left Coast Fitness (Copy)

CHANGE IN ACCOUNT

We know it doesn't always work out. Your membership cancellation request requires a 7-day notice prior to your billing date to avoid further charges. You will be billed again if notice is not received seven days prior to your billing date. No refunds.

Name

First Name

Last Name

Date

YYYY

Please select the membership option/s you will be cancelling

Basic Month to Month Membership

Open Gym Membership

You will receive an email response confirming your request. What is the best e-mail to receive an e-mail?

I understand that this from is a request to cancel my membership. Further, by submitting it, I acknowledge that I will be responsible for any charges regarding my membership if this form is not received seven days prior to my billing date. I understand that charges made if the form is not received in the time requested will not be refunded. To sign, please type your full name and today's date