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MEMBERSHIP CANCELLATION REQUEST th

4203 70 Avenue 40 Riverside Way 210-500 Timberlands Dr. 10629 West Side Drive 7407 108 Avenue
Lloydminster, AB Okotoks, AB Red Deer, AB Grande Prairie, AB Clairmont, AB
T9V 3L9 T1S 1M3 T4P 0Z4 T8V 8E6 T0H 0W0
(780)871-0641 (403)938-2233 (587)272-1003 (780)538-1003 (780)830-3880

*These facilities are a franchise of Motion Fitness and are independently owned and operated

MEMBER INFORMATION
TODAYS DATE: Member #:
First Name: Home Phone:
Last Name: Cell Phone:

NOTICE:
 Any membership can be cancelled with 30 days written notice. (Refer to the Membership Terms & Conditions
on your contract).
 If your current Agreement states a different cancellation notice period from what this form states, your
membership agreement cancellation term WILL be honored
 You are responsible for all payments within the 30 days following the received date of this form to our office.
**Your last payment will include the Annual Enhancement Fee if not already paid for the year.
 Annual Enhancement Fee: If this cancellation notice is received before the date of your annual enhancement fee
for this year, your last biweekly payment will include the Annual Enhancement Fee.
 If account is in arrears, balance owing will continue to be withdrawn even after the cancellation date takes effect.
Any declines will be subject to a return fee as per the terms of your agreement.

Reason for Request to Cancel:

________________________________________________________________________________
________________________________________________________________________________
If Cancelling due to relocating, please provide forwarding address (REQUIRED):
________________________________________________________________________________
________________________________________________________________________________
This is just a request, you will receive an email confirmation apon approval once your request is processed in accordance
to your agreement with Motion Fitness.

Date of Cancellation Submission Request: ____________________________

FOR
HEAD Last Biweekly Payment: ____________________________

OFFICE Last Day to Use the Facilities: ____________________________

USE Cancellation Effective: ____________________________

By my signature below, I have read, understand and agree to the “Notice” section of this form.

Member’s Signature: _______________________________________________