Membership Cancellation Form

Fitness Center
MEMBERSHIP CANCELLATION FORM
Form Type
Name*
Member*
Address*

Address

Street Address Line 2

CityState

Zip
Email
example@example.com
Home Phone
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Cell Phone
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CANCELLATION:
PREPAID/PIF (PAID IN FULL) MEMBERSHIP PLANS REQUIRE A FULL YEAR COMMITMENT AND ARE NON-REFUNDABLE.

EFT/Monthly Membership Plans may be cancelled, at any time and for any reason, by paying up any outstanding account balances in full & completing the YVY Fitness Center Membership Cancellation Form, available at the Fitness Center, or by written notice, via certified mail, return receipt requested to YVY Fitness Center, 1312 38th Street, SUITE 515, Brooklyn, New York 11218, by the 1st of the month prior to the cancellation date. If Cancellation is not submitted by the 1st of the month, member may be billed for the month, and if so may continue to use the YVY Fitness Center during this time. Initiation Fees are non-refundable.
REASON FOR CANCELLATION*

RateHoursServiceMovingPersonalOther
Today's Date

MonthDayYear
Date
Member Signature*

Clear
Member Signature Date

MonthDayYear
Date
Signature of Parent or Guardian (Members under 18)

Clear
Parent or Guardian Signature Date

MonthDayYear
Date
For Official Use Only
Membership Cancellation Effective as of:

MonthDayYear
Date
Staff Signature

Clear
Staff Signature Date

MonthDayYear
Date
Yeled Yalda your child, our world

1312 38th Street Brooklyn, NY 11218 - 718.686.3700 www.yeled.org
Should be Empty:

Fitness Center

MEMBERSHIP CANCELLATION FORM

CANCELLATION: