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PRSVR Membership Cancellation Form 
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First And Last Name  *
E-mail *

PLEASE SELECT THE OPTION BELOW THAT BEST DESCRIBES YOUR REASON FOR LEAVING

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HOW WELL DID THE COACHING STAFF ATTEND TO YOUR FITNESS GOALS AND NEEDS?

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HOW WOULD YOU DESCRIBE YOUR SATISFACTION WITH THE FACILITIES INCLUDING EQUIPMENT, PARKING, AND ACCESSIBILITY?

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OVERALL, HOW WOULD YOU RATE YOUR EXPERIENCE (10 BEING AWESOME)?

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Not Good
Awesome
Please Check the Following Boxes Below
I understand that my membership will be canceled 4 weeks from the submission of the form below. (Note that if you have a scheduled renewal payment within this 4 week period, the payment will be processed as scheduled. All payments are non-refundable.)
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Required
I understand that cancellation of my membership prior to the expiration of any specified commitment period requires an early termination fee equal to the difference of the membership rate I was on to the membership rate I should have been on according to the term length I fulfilled.
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Required
I understand that this will serve as my 4 week written cancellation notice as required by the membership agreement.
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Required
I understand that if I decide to reactivate my membership in the future (and we hope you do) membership rates in effect at the time of reactivation will be applicable as membership rates are subject to change.
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Required
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