Modo Yoga LA Membership Cancellation Request

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Your Be Awesome Membership request can be submitted after 2 payments have been made, 7 days before your next pre-authorized payment. Please provide the following information to request cancellation. Cancellation requests are processed within 48 hours and you will receive a confirmation email upon processing. (NOTE: Completing this form will not automatically terminate your membership, but submits your request for processing.)

MEMBER FIRST NAME *

MEMBER LAST NAME *

MEMBER PHONE NUMBER *

MEMBER EMAIL ADDRESS *

MEMBER HOME STUDIO *

East

La Brea

West

WHEN WOULD YOU LIKE THE CANCELLATION TO TAKE EFFECT? (Please note: Your cancellation date cannot be backdated.) *

YYYY

REASON FOR CANCELLATION *

Moving

Injury or health reason

Traveling for longer than 3 months

Joining another fitness studio or gym

Schedule and/or time limits

Financial

No convenient studio locations

Other:

I understand that my request must be submitted 7 days in advance of my next pre-authorized payment date in order to avoid an additional monthly charge.

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